Oscar F. Lopez Nunez, MD; Jennifer Picarsic, MD.
The patient was an otherwise healthy girl, who first noted the lump approximately two years ago without any significant change over time. There was no apparent history of trauma and no apparent history of intercurrent illness at that stage. No associated redness, discharge or skin changes were noted. The mass became slightly tender, especially to palpation. She denied the presence of additional masses anywhere else. On physical examination, a single mass was palpated in the upper anterior triangle to the left of the midline, approximately 2-3 cm under the mandible and above and lateral to the thyroid and cricothyroid cartilage. The mass did not move with tongue protrusion. The lump itself was approximately 8 mm in diameter, felt cystic in nature, and was mobile under the skin and to the deep structures. There was no skin discoloration. No dimple or sinus tracts were noted. The patient complained of mild tenderness to palpation. The rest of her exam was unremarkable. Targeted ultrasound of the right neck demonstrated the presence of a slightly lobular 1.1 x 1.1 x 0.5 cm ovoid lesion that appeared to have two fatty hila with central vessels. The lesion was located in the subcutaneous fat. No abnormal tract was seen extending from the area. No fluid collection was seen. The ultrasonographic diagnostic impression suggested a benign bilobed lymph node. Surgical excision of the mass was subsequently scheduled and the specimen was submitted for pathology examination (See Figures 1 to 5).