Differential Diagnosis for Palpable Neck Lump
- Single most likely diagnosis
- Epidermoid cyst: This is the most likely diagnosis given the description of a multiloculated complex cystic mass in the subcutaneous tissue with minimal vascularity. Epidermoid cysts are common, benign lesions that can present as palpable lumps and often have a complex cystic appearance on ultrasound.
- Other Likely diagnoses
- Sebaceous cyst: Similar to epidermoid cysts, sebaceous cysts are benign lesions that can appear as complex cystic masses on ultrasound. They are also located in the subcutaneous tissue and can have minimal vascularity.
- Branchial cleft cyst: Although less common, branchial cleft cysts can present as complex cystic masses in the neck, particularly if they become infected or inflamed. However, they are typically more deeply located and may have more significant vascularity.
- Thyroglossal duct cyst: These cysts can appear as complex masses in the neck, but they are usually more midline and may have a more significant connection to the hyoid bone or the thyroid gland.
- Do Not Miss diagnoses
- Metastatic lymph node: Although the description suggests a benign cystic lesion, it is crucial not to miss a metastatic lymph node, which could have a similar appearance, especially if the primary cancer is not yet diagnosed. The lack of significant vascularity and the subcutaneous location make this less likely, but it remains a critical consideration.
- Infected cyst or abscess: An infected epidermoid or sebaceous cyst could present with similar ultrasound findings and would require prompt treatment to avoid complications.
- Rare diagnoses
- Dermoid cyst: While dermoid cysts can appear as complex cystic masses, they are less common than epidermoid or sebaceous cysts and often contain more echogenic material due to the presence of hair, teeth, or other dermal elements.
- Cystic hygroma: Typically presenting in childhood, cystic hygromas are benign lymphatic malformations that can appear as complex cystic masses in the neck. They are less likely in adults and usually have a more significant and deeper extension.
- Cystic teratoma: Although rare, cystic teratomas can occur in the neck and appear as complex cystic masses. They often contain echogenic material and may have a more significant solid component.