From the Guidelines
Given your symptoms of pain, numbness, and tingling associated with a 15 cm diameter lump at the base of your neck, previously identified as a "buffalo hump," it is crucial to proceed with the ordered ultrasound to evaluate the lump and then discuss potential treatment options based on the findings. The lump's size and your symptoms suggest that it could be causing significant discomfort or potentially compressing nerves, which necessitates a thorough evaluation. A "buffalo hump" (dorsocervical fat pad) is typically a collection of fat that develops at the base of the neck, but when it causes pain, numbness, and tingling, further evaluation is necessary to rule out other underlying conditions 1. The clinical practice guideline for the evaluation of neck masses in adults recommends identifying patients at increased risk for malignancy based on history, physical examination, and imaging studies 1, 2. The ultrasound ordered by your doctor is an appropriate initial step in evaluating the nature of the lump, as it will help determine if the lump is purely fatty tissue or if there might be another underlying condition that needs to be addressed. Treatment options will depend on the ultrasound findings but may include medication to address any underlying causes, steroid injections to reduce inflammation if present, physical therapy to strengthen neck muscles, or in some cases, surgical removal if the lump is causing significant discomfort or compression of nerves. In the meantime, you might find relief with over-the-counter pain medications like acetaminophen or ibuprofen (unless contraindicated for you), applying ice or heat to the area, and avoiding activities that worsen your symptoms 1. However, these are temporary measures while awaiting definitive diagnosis and treatment recommendations after your ultrasound. It's also important to note that if the ultrasound findings suggest a need for further evaluation, such as contrast-enhanced CT or MRI, these imaging modalities can help localize and characterize the mass, assess for additional nonpalpable masses, and screen visualized organs for potential sites of primary malignancy 2.
From the Research
Diagnostic Approaches for Neck Lump
The patient presents with a lump at the base of the neck, measuring around 15 cm in diameter, accompanied by pain, numbness, and tingling. To evaluate this lump, an ultrasound (US) of the back of the neck has been requested, and a follow-up appointment will be scheduled to review the US notes.
Imaging Modalities
- Ultrasound is a cost-effective imaging modality that does not expose patients to ionizing radiation and can provide real-time data 3.
- Magnetic Resonance Imaging (MRI) produces clearer images of tissues, body fluids, and fat compared to x-ray, CT, and ultrasound, making it a valuable tool for diagnosing neurological conditions 4, 5.
- The choice of imaging modality and protocol depends on the clinical information provided, highlighting the importance of understanding how imaging modalities work and their limitations 5.
Clinical Evaluation
- A thorough neurological examination is essential for localization and diagnosis, even with the availability of advanced imaging and electrophysiology techniques 6.
- The neurological examination provides accuracy in localization, enabling technology to aid in diagnosis effectively and efficiently.
Sedation Strategies for Imaging
- Sedation may be necessary for patients undergoing MRI procedures, particularly those with anxiety or an inability to remain still 7.
- Commonly used intravenous sedatives include fentanyl, butorphanol, and midazolam, each with its advantages and limitations, and individualized sedation planning is crucial to enhance patient experience and procedural outcomes 7.