Patients or their relatives may notice a neck swelling, or it is discovered during a routine examination. A neck swelling can, depending on the cause, painless or painful to be. If the throat swelling is painless, much time can elapse before the patient visits a doctor. Etiology There are many causes of neck swelling, including infectious diseases, cancer and congenital causes (see Table: causes of neck swelling). Causes of neck swelling cause suspicious findings diagnostic approach Infectious diseases HIV high-risk groups Generalized painless adenopathy Serological tests for HIV mononucleosis Several, not painful or moderately painful cervical lymph nodes in an adolescent Usually pharyngitis and intense malaise Serological tests for Epstein-Bar r virus Viral or bacterial oropharyngeal infection (usually pharyngitis or infections of the upper respiratory tract, sometimes a tooth infection) Common symptoms of infection of the upper respiratory tract, sore throat or toothache Acute rubbery adenopathy with little or no tenderness Occasionally several enlarged node in connection with infection of the upper respiratory tract Clinical evaluation Occasionally throat swab Primary, bacterial lymphadenitis Acute, isolated, pressure-sensitive adenopathy Clinical evaluation TB High-risk groups Matted, painless adenopathy, occasionally fluctuating Mantoux test (PPD) Cultural cancer * Local primary tumors (eg. B. oropharynx, thyroid, salivary glands) nodes from distant primary tumors (eg. B. lymphoma, prostate, breast, colon, kidney) node (local or regional primary tumors z. B. lung, upper gastrointestinal tract) for the most frequent local primary tumors, most in the elderly, usually associated with significant tobacco and / or alcohol use; Primary tumor can be visible or palpable or not (eg in the oropharynx.) Cancerous masses probably plump or hard and firm to the underlying tissue instead moveable regional or distant metastases, with or without local symptoms neck swelling: Laryngoscopic tests Usually, bronchoscopic and ösophagoskopische investigation biopsies from all suspicious districts CT scan of the head, neck and chest, possibly thyroid scintigraphy Congenital disorders gills duct cyst Lateral mass, usually above the sternocleidomastoid, often with a sinus or a fistula in children sonography in adults CT Dermoid or atheroma Gummy and not painful (unless infected) thyroglossal non-painful mass in the midline usually start later Other Diseases Manifested in childhood or adolescence, occasionally: Simple nontoxic goiter Not painful diffuse enlargement of the thyroid tests of thyroid function thyroid scintigraphy sonography Subacute Thyreoidit is fever, usually tenderness and enlargement of the thyroid enlargement of submandibular gland (eg. B. due to Sialadenitis or stones) Typically painless mass just below the lateral mandibular CT and MRI biopsy * patients with suspected cancer should undergo a head and neck examination by an ENT specialist. The most common causes in younger patients include reactive arthritis primary bacterial infection of the lymph nodes systemic infections Reactive adenitis is in response to a viral or bacterial infection anywhere in the oropharynx. Cervical lymph nodes may be enlarged also be due to a systemic infection (eg, mononucleosis, HIV, TB.) – but then more generalized rather than isolated. Hereditary disorders can lead to persistent usually neck swelling. The most common are thyroglossal, gills duct cysts, dermoid or atheroma. Malignant lesions are more common in older patients, but can also occur in younger patients. These lesions may be a local primary tumor or lymph node involvement following a local, regional or distant primary tumor. About 60% of palpable in the supraclavicular triangle swelling are distant metastases of a primary tumor. 80% of the cancerous lymphadenopathy in the neck other areas start from the upper respiratory or digestive tract. As wahrscheinlichster seat of a primary tumor, especially the posterior tongue margins and floor of the mouth are eligible, followed by nasopharynx, tonsils, laryngeal epiglottis and hypopharynx (with recess piriform). The thyroid gland can increase in various diseases, including with simple nontoxic goiter, subacute thyroiditis, and, less frequently, for thyroid cancer. The submandibular gland may be increased if it is blocked by a stone, is infected or develops a tumor. Clarification history The history of the disease process should determine how long the mass is and whether it is painful. Important related acute symptoms are sore throat, toothache and symptoms of infections of the upper respiratory tract. In reviewing the organ systems (eg., Fever, weight loss, malaise) should be asked about difficulty swallowing or speaking and symptoms of chronic disease. Regional and distant tumors that lead to metastasis in the neck sometimes cause symptoms in their home system (z. B. cough in lung cancer, dysphagia in oesophageal cancer). Because many cancers can metastasize to the neck, a full review of organ systems is important to identify the source. The medical history should also by a known HIV or TB infection and ask their risk factors. Clarify are potential risk factors for cancer – such as alcohol or tobacco use (especially snuff or chewing tobacco), ill-fitting dentures and chronic oral thrush (oral candidiasis). Also, poor oral hygiene may be at increased risk darstellen.Körperliche investigation The neck swelling is scanned to determine the consistency (i. E., Whether it is soft and fluctuating, rubbery or hard) and to the presence and degree of tenderness determine. Whether the swelling freely movable or is fixed to the skin or the underlying tissue also needs to be clarified. During the inspection of the scalp, ears, nose and oral cavity, pharynx (nasopharynx, oropharynx, hypopharynx) and larynx is very vigilant for signs of infection or other visible lesions. The teeth are knock off to recognize the extreme sensitivity to touch a root infection. Base of the tongue, floor of the mouth, thyroid and salivary glands are palpated on masses. Breast and prostate are examined for lesions and the spleen is scanned for magnification. The chair is checked for occult blood, which justified the suspicion of a tumor in the gastrointestinal tract. More lymph nodes are scanned (eg armpits, groin). .Warnzeichen The following findings are particularly important: hard, solid masses elderly patient oropharyngeal lesions (apart from simple pharyngitis or dental infection) persistent hoarseness or difficulty swallowing in the history of interpretation of the findings important differentiators in lesions in the throat (see table: causes of neck swelling) are deferred, pain and tenderness as well as consistency and mobility. A new mass (which develops within a few days), particularly for symptoms to an infection of the upper respiratory tract or pharyngitis, suggests a benign reactive lymphadenopathy. An acute pressure-sensitive swelling is suggestive of lymphadenitis or an infected dermoid cyst. A chronic swelling in younger patients suggests a cyst. A non-midline localized swelling in the elderly, especially those with risk factors should suggest a cancer until proven otherwise; localized in the midline swelling has its origin (benign or malignant) probably in the thyroid. Pain and / or tenderness indicate an (infectious) inflammation, while a painless swelling could be caused by a cyst or a tumor. A hard, painless node that is not displaced could be malignant, whereas rubbery consistency and displaceability rather speaks to the contrary. In splenomegaly and generalized lymphadenopathy a suspicion of infectious mononucleosis or malignant lymphoreticular variation is obvious. A generalized lymphadenopathy alone could indicate HIV infection, particularly in patients with risk factors. Red and white mucous patches (Erythroplakia and leukoplakia) in the oropharynx can be malignant lesions that are responsible for the swelling. Difficulty swallowing can be found at a magnification of thyroid or tumors that originate in different locations in the neck. Difficulty speaking indicate a cancer that the larynx or the recurrent laryngeal nerve betrifft.Tests If it is readily apparent to is what kind of swelling (z. B. lymphadenopathy after a pharyngitis), or when a pressure-sensitive swelling developed without further findings in a healthy young person recently, no immediate clarification must be made. Patients should be examined at regular intervals to see if the swelling goes down; if not, further investigations are necessary. For most other patients it will be the swelling by ultrasound, may examine the blood (complete blood count) and the chest X-ray. Patients with findings that have a specific cause suspect should also be studied in this disease (see table: causes of neck swelling). If oral or nasopharyngeal lesion has not improved within 2 weeks after diagnosis, tests such as X-ray, CT, MRI, or a fine needle biopsy of the lesion to be performed. In younger patients with no risk factors for head and neck tumors and no other apparent lesions, a biopsy of the node is possible. In the elderly – and especially if risk factors are present – must be sought only after the seat of the primary tumor; otherwise the neck node biopsy could easily prove only an undifferentiated carcinoma, without giving information on its origin. Such patients should be directly laryngoscopy, bronchoscopy and ösophagoskopisch examined (to take advantage of all suspicious districts samples). Samples that are identified as squamous cell carcinoma should be tested for HPV. In addition to the CT scan of the head, neck and chest a thyroid scintigraphy may should be performed. Ultrasound is preferred for children, in order to avoid exposure to radiation and can be used in adults, when a mass of the thyroid is suspected. there is no primary tumor, should be a fine needle biopsy of the node, which is preferable to a incisional biopsy, since no debris in the neck remain. If it is a malignant lesion and can not detect the primary tumor biopsies of the nasopharynx, Gaumentonsillen and base of the tongue should be considered. The therapy treatment depends on the particular cause. Summary An acute throat swelling in younger patients is usually benign. A throat swelling of an elderly patient is cause for concern that a cancer is present. A thorough oropharyngeal examination is important.