Lump in the Anterior Triangle

CLINICAL DIAGNOSIS MANUAL

A lump in the anterior triangle of the neck can be a concerning clinical finding and requires a thorough evaluation to determine its nature and origin. The anterior triangle of the neck is bordered by the anterior edge of the sternocleidomastoid muscle, the midline of the neck, and the lower border of the mandible.

Masses in this region can be caused by a variety of pathologies, ranging from acute infections to malignant neoplasms. Clinical evaluation must be meticulous and include a complete medical history, detailed physical examination, and specific complementary tests.

Pathology	Symptoms and Clinical Signs	Diagnosis of Suspicion	Diagnosis of Confirmation
Inflammation of Lymph Nodes	Neck pain, fever, systemic infection symptoms. Enlarged lymph nodes, tender on palpation, may be mobile or fixed.	Clinical history and physical examination. Full blood count: Leukocytosis.	Neck ultrasound: Reactive lymph nodes.
Acute Abscess	Severe pain in the affected area, fever, general malaise. Fluctuant, painful mass, erythema and local warmth, possible pus drainage.	Clinical history and physical examination. Neck ultrasound: Pus collection.	Aspiration culture: Identification of the causative microorganism.
Tuberculous Abscess	Chronic neck pain, low-grade fever, night sweats, weight loss. Fluctuant mass, initially painless, may drain pus through the skin (fistula).	Clinical history and physical examination. Tuberculin test (PPD): Positive.	Mycobacterium tuberculosis culture: From aspirated material.
Branchial Cyst	Painless neck mass, may enlarge with respiratory infections. Mobile and non-tender mass, may be present since childhood.	Clinical history and physical examination. Neck ultrasound: Well-defined cystic mass.	Computed tomography (CT): Detailed cystic characteristics.
Cystic Hygroma	Painless neck mass, usually present from birth. Soft, translucent, slow-growing mass.	Clinical history and physical examination. Neck ultrasound: Multilobulated cystic mass.	Magnetic resonance imaging (MRI): Assessment of the extent and characteristics of the hygroma.
Pharyngeal Pouch	Difficulty swallowing, sensation of a lump in the throat. Palpable neck mass, may fluctuate in size with swallowing.	Clinical history and physical examination. Barium swallow: Visualisation of the pharyngeal pouch.	Neck MRI: Anatomical details of the mass.
Carotid Body Tumour	Painless neck mass, possible dizziness or syncope. Pulsatile, palpable mass, mobile laterally but not vertically.	Clinical history and physical examination. Doppler ultrasound: Increased vascularisation of the mass.	Angiography: Visualisation of the carotid artery and its relationship with the mass.
Lymphoma	Fatigue, weight loss, night sweats, fever. Enlarged, painless, firm, and mobile lymph nodes.	Clinical history and physical examination. Node biopsy: Initial histopathological examination.	Positron emission tomography (PET): Assessment of disease extent.