Head and Neck Differntial Diagnoses

Contents: Fat, internal maxillary artery, ascending pharyngeal artery, pharyngeal venous plexus.

Pseudomass

Asymmetric pterygoid venous plexus*

Congenital

Atypical second branchial cleft cyst

Inflammatory

Abscess spread from adjacent deep facial spaces, especially*:
- PMS: Adenoids, tonsils
- Parotid space: calculus disease
- Masticator space: Odontogenic infection

Benign tumor

Pleomorphic adenoma (benign mixed tumor) of salivary gland rest in the PPS
Lipoma

Malignant tumor

Salivary gland rest in the PPS
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
- Alignant mixed tumor
Direct spread of malignant tumor from adjacent deep fascial space, especially*:
- PMS: Squamous cell carcinoma, non-Hodgkin's lymphoma, minor salivary gland malignancy
- Masticator space: Sarcoma
- Parotid space: Mucoepidermoid carcinoma, adenoid cystic carcinoma

Contents: Mucosa, lymphoid tissue of Waldeyer's ring (adenoids, tonsils), minor salivary glands, pharyngobasilar fascia, superior and middle constrictor muscles, salpingopharyngeus muscle, levator palatini muscle, cartilaginous end of the eustachean tube.

Pseudomass

Asymmetric fossa of Rosenmuller
Mucosal inflammation from infectious or radiation induced pharyngitis

Congenital

Thornwaldt cyst

Inflammatory

Adenoidal or faucial tonsil hypertrophy
Adenoidal or faucial tonsillitis
Adenoidal or faucial tonsil abscess
Postinflammatory dystrophic calcification
Postinflammatory retention cyst

Benign tumor

Benign mixed tumor of minor salivary gland origin

Malignant tumor

Squamous cell carcinoma
Non-Hodgkin lymphoma
Minor salivary gland malignancy

Contents: Muscles of mastication (masseter, temporalis, medial pterygoid, lateral pterygoid), masticator nerve branches (proximal V₃ motor branch), inferior alveolar nerve (V₃ sensory branch), inferior alveolar vein and artery, ramus and posterior body of the mandible.

Pseudotumor

Accessory parotid gland*
Benign masseteric hypertrophy*
Cranial nerve V₃ degeneration atrophy

Congenital

Hemangioma
Lymphangioma

Inflammatory

Odontogenic abscess*
Mandibular osteomyelitis

Benign tumor

Osteoblastoma
Leiomyoma
Nerve sheath tumor (neurofibroma, schwannoma)

Malignant tumor

Sarcoma*: Soft tissue, Chondrosarcoma, Osteosarcoma
Malignant schwannoma
Non-Hodgkin lymphoma*
Squamous cell carcinoma from oropharynx (retromolar trigone)*
Rhabdomyosarcoma (pediatric)*
Mandibular metastases

Contents: parotid gland, facial nerve(CN VII), retromandibular vein, external carotid artery, intraparotid lymph nodes.

Congenital

First branchial cleft cyst
Hemangioma (pediatric)
Lymphangioma (pediatric)

Inflammatory

Abscess or cellulitis
Benign lymphoepithelial lesions (AIDS)
Reactive adenopathy

Benign tumor

Pleomorphic adenoma (benign mixed tumor)*
Warthin's tumor (papillary cystoadenoma lymphomatosum)*
Oncocytoma
Lipoma
Facial nerve schwannoma or neurofibroma

Malignant tumor, primary

Mucoepidermoid carcinoma*
Adenoid cystic carcinoma*
Non-Hodgkin lymphoma
Acinic cell carcinoma
Malignant mixed tumor
Squamous cell carcinoma

Malignant tumor, metastatic (within parotid nodes)

Skin: Squamous cell carcinoma*
Melanoma*
Non-Hodgkin lymphoma

Inflammatory or infectious

Reactive lymphadenopathy
Benign lymphoepithelial lesions (AIDS)
Sarcoid

Primary tumor

Warthin's tumor
Acinic cell carcinoma
Non-Hodgkin lymphoma (within parenchyma)

Nodal tumor

Metastatic tumor
Non-Hodgkin lymphoma (within parotid nodes)
Skin malignancy
Squamous cell carcinoma
Melanoma

Contents: CCA and ICA, internal jugular vein, CNs IX, X, XI, XII (nasopharyngeal level), CN X only (oropharyngeal and infrahyoid levels are).

Pseudomass

Ectatic common or internal carotid artery*
Asymmetric internal jugular vein*

Inflammatory

Carotid space cellulitis or abscess

Vascular lesions

Jugular vein thrombosis or thrombophlebitis*
Internal carotid artery thrombosis, mural thrombus, aneurysm, or pseudoaneurysm*
Internal carotid artery dissection

Benign tumor

Paraganglioma* (glomus jugulare, glomus vagale, carotid body tumor)
Nerve sheath tumor (schwannoma*, neurofibroma)
Meningioma (from jugular foramen)

Malignant tumor

Squamous cell carcinoma nodal metastasis*
Direct invasion by primary squamous cell carcinoma
Non-Hodgkin lymphoma

Contents: Fat, lymph nodes (lateral [Rouviere]: in high oropharynx and nasopharynx, medial: from nasopharynx to upper hypopharynx).

Pseudomass

Tortuous carotid artery
Edema secondary to deep venous or lymphatic obstruction

Congenital

Hemangioma
Lymphangioma

Inflammatory

Reactive adenopathy*
Cellulitis*
Suppurative adenopathy (intranodal abscess)*
Abscess*

Benign tumor

Lipoma

Malignant tumor

Nodal metastases
- Squamous cell carcinoma of head and neck origin (especially from nasopharynx)*
- Melanoma
- Thyroid carcinoma
Nodal non-Hodgkin's lymphoma*
Direct invasion from primary squamous cell carcinoma (especially posterior wall primary lesions)*

Contents - Prevertebral portion: Prevertebral muscles, scalene muscles (anterior, middle, and posterior), brachial plexus, phrenic nerve, vertebral artery and vein, vertebral body. Paraspinal portion: Paraspinal muscles, posterior elements of the vertebra.

Pseudomass

Vertebral body osteophyte*
Anterior disc herniation
Levator scapulae hypertrophy
Large or asymmetric transverse process
Cervical rib
Hypertrophic facet joint

Vascular

Vertebral artery dissection, aneurysm, or pseudoaneurysm

Inflammatory

Vertebral body osteomyelitis*
- Pyogenic osteomyelitis
- Tuberculous spondylitis

Benign tumor

Schwannoma, neurofibroma (brachial plexus)
Vertebral body benign bony tumors

Malignant tumor

Chordoma*
Vertebral body or epidural metastasis*
Non-Hodgkin lymphoma
Direct invasion by squamous cell carcinoma
Vertebral body primary malignant tumor

Contents: epithelial lining, minor salivary glands.

Congenital/Developmental

Hemangioma
Lymphangioma/Cystic hygroma
Lingual thyroid tissue

Inflammatory

Ludwig's angina/cellulitis*
Odontogenic infection

Benign tumor

Benign tumor of minor salivary gland origin

Malignant tumor

Squamous cell carcinoma*
Minor salivary gland malignancy

Contents: Anterior extension of the hyoglossus muscle, lingual nerve (sensory branch of V₃ with chorda tympani branch of VII), CNs IX and XII, lingual artery and vein, sublingual glands and ducts, deep portion of submandibular gland, submandibular gland duct (Wharton's duct).

Pseudomass

Hypoglossal nerve motor atrophy

Congenital/developmental

Hemangioma
Lymphangioma/cystic hygroma
Epidermoid/dermoid*
Lingual thyroid tissue

Inflammatory

Ludwig's angina/cellulitis*
Abscess
dilated submandibular gland duct secondary to stenosis or calculus*
Ranula, simple or diving

Benign tumor

Benign tumor of minor salivary gland origin

Malignant tumor

Squamous cell carcinoma invading anteriorly from the tongue base or inferiorly from the mucosal surface of the oral tongue*
Sublingual gland malignant tumor
- Adenoid cystic carcinoma
- Mucoepidermoid carcinoma
- Acinic cell carcinoma

Contents: Anterior belly of digastric muscle, superficial portion of submandibular gland, submandibular and submental lymph nodes, facial vein and artery, inferior loop of hypoglossal nerve (CN XII), fat.

Pseudomass

Cranial nerve V₃ motor atrophy (anterior belly of digastric muscle and mylohyoid muscle)

Congenital/developmental

Second branchial cleft cyst*
Suprahyoid thyroglossal duct cyst
Lymphangioma/cystic hygroma*
Hemangioma*

Inflammatory

Ludwig's angina/cellulitis*
Reactive adenopathy*
Submandibular gland inflammation secondary to ductal stenosis, calculus, tumor*
Diving ranula

Benign tumor

Lipoma*
Epidermoid/dermoid
Benign mixed tumor of submandibular gland
Tail of parotid pedunculated benign tumor (benign mixed tumor or Warthin's tumor)

Malignant tumor

Nodal metastasis of squamous cell carcinoma of the face and oral cavity*
Nodal lymphoma*
Submandibular gland malignancy (adenoid cystic carcinoma, mucoepidermoid carcinoma)
Direct invasion by squamous cell carcinoma of the oral cavity

Contents: thyroid gland, parathyroid gland, hypopharynx, larynx, trachea, esophagus, recurrent laryngeal nerve, paraesophageal (paratracheal) lymph nodes.

Pseudomass

Pyramidal lobe of thyroid gland
Prominent thyroid isthmus
Post-traumatic larynx
Patulous esophagus in tracheoesophageal groove (parathyroid adenoma mimic)

Congenital/developmental

Infrahyoid thyroglossal duct cyst

Laryngeal lesions

Squamous cell carcinoma
Chondrosarcoma
Laryngocele

Thyroid lesions

Colloid cyst
Goiter
Adenoma
Carcinoma (papillary, follicular, mixed)
Anaplastic carcinoma
Non-Hodgkin lymphoma
Metastasis

Parathyroid lesions

Adenoma
Cyst

Esophageal lesions

Zenker's diverticulum
Carcinoma

Paraesophageal (paratracheal) nodal lesions

Thyroid carcinoma metastases
Squamous cell carcinoma metastases (treated neck)
Lymphoma
Other metastases

visceral space inflammation

Abscess
Hashimoto thyroiditis

Contents: CCA, internal jugular vein, vagus nerve proper, sympathetic chain, deep cervical lymph nodes.

Pseudomass

Carotid bulb asymmetry
Carotid artery ectasia
Jugular vein asymmetry

Congenital/developmental

Infrahyoid second branchial cleft cyst

Inflammatory

Abscess
Deep cervical chain
- Reactive adenopathy
- Suppurative adenopathy
- Tuberculous adenitis

Vascular

Jugular vein thrombosis/thrombophlebitis
Carotid artery posttraumatic pseudoaneurysm

Benign tumor

Carotid body tumor (paraganglioma)
Nerve sheath tumor (schwannoma, neurofibroma)

Malignant tumor

Deep cervical chain
- Squamous cell carcinoma
- Thyroid carcinoma
- Non-Hodgkin lymphoma
- Hodgkin lymphoma
- Metastasis (lung, abdomen)

Contents: Fat, spinal accessory nerve (CN XI), spinal accessory lymph node chain, preaxillary brachial plexus, dorsal scapular nerve.

Congenital/Developmental

Cystic hygroma, lymphangioma
Hemangioma

Inflammatory

Abscess
Posterior cervical chain
- Reactive adenopathy
- Suppurative adenopathy
- Tuberculous adenitis

Benign tumor

Lipoma
Nerve sheath tumor (schwannoma, neurofibroma)

Malignant tumor

Posterior cervical chain
- Squamous cell carcinoma (nasopharynx)
- Non-Hodgkin lymphoma
- Hodgkin lymphoma
Liposarcoma

Congenital cystic neck masses

Branchial cleft cysts
- First (periparotid)
- Second (posterior submandibular space)
- Third (posterior cervical space)
Thyroglossal duct cyst
Lymphangioma/Cystic hygroma spectrum
Thornwaldt cyst

Inflammatory cystic masses

Abscess
Suppurative adenopathy
Granulomatous adenopathy
Ranula
Retention cyst (vallecular, tonsillar, adenoidal)

Vascular cystic masses

Jugular venous thrombosis-thrombophlebitis
Aneurysm (carotid, vertebral)

Viscera saccular cysts

Laryngocele
Zenker's diverticulum

Parenchymal cysts

Thyroid cyst
Parathyroid cyst
Thymic cyst

Benign cystic tumors

Nerve sheath tumor (schwannoma, neurofibroma)
Lipoma (clinically "cystic")

Malignant cystic tumors

Primary squamous cell carcinoma
Nodal squamous cell carcinoma
Primary or nodal thyroid carcinoma

Parotid space: Suprahyoid neck – Periparotid area

First branchial cleft cyst
Cystic hygroma
Abscess, suppurative node
Obstructed parotid duct, sialocele
Warthin's tumor
Cystic schwannoma, neurofibroma
Malignant necrotic adenopathy
Mucoepidermoid carcinoma

Posterior submandibular space: Angle of the mandible

Second branchial cleft cyst
Cystic hygroma
Dermoid
Mixed (external) laryngocele
Submandibular gland mucocele
Abscess, suppurative node (submandibular chain)
Diving ranula
Lipoma
Malignant necrotic adenopathy (submandibular chain)

Sublingual space: Oral cavity

Epidermoid
Simple ranula
Obstructed submandibular duct, sialocele

Carotid space

Jugular vein thrombosis
Carotid artery aneurysm or pseudoaneurysm
Abscess, suppurative adenopathy (deep cervical chain)
Malignant necrotic adenopathy (deep cervical chain)

Visceral space: Midline neck

Thyroglossal duct cyst
Internal (simple) laryngocele
Cystic benign thyroid or parathyroid tumor
Malignant laryngeal squamous cell carcinoma
Cystic malignant thyroid tumor

Posterior cervical space: Posterior triangle area

Cystic hygroma
Abscess, suppurative adenopathy (spinal accessory chain)
Cystic schwannoma, neurofibroma
Malignant necrotic adenopathy (spinal accessory chain)

Head & Neck Differntial Diagnoses

Pseudomass

Congenital

Inflammatory

Benign tumor

Malignant tumor

Pseudomass

Congenital

Inflammatory

Benign tumor

Malignant tumor

Pseudotumor

Congenital

Inflammatory

Benign tumor

Malignant tumor

Congenital

Inflammatory

Benign tumor

Malignant tumor, primary

Malignant tumor, metastatic (within parotid nodes)

Inflammatory or infectious

Primary tumor

Nodal tumor

Pseudomass

Inflammatory

Vascular lesions

Benign tumor

Malignant tumor

Pseudomass

Congenital

Inflammatory

Benign tumor

Malignant tumor

Pseudomass

Vascular

Inflammatory

Benign tumor

Malignant tumor

Congenital/Developmental

Inflammatory

Benign tumor

Malignant tumor

Pseudomass

Congenital/developmental

Inflammatory

Benign tumor

Malignant tumor

Pseudomass

Congenital/developmental

Inflammatory

Benign tumor

Malignant tumor

Pseudomass

Congenital/developmental

Laryngeal lesions

Thyroid lesions

Parathyroid lesions

Esophageal lesions

Paraesophageal (paratracheal) nodal lesions

visceral space inflammation

Pseudomass

Congenital/developmental

Inflammatory

Vascular

Benign tumor

Malignant tumor

Congenital/Developmental

Inflammatory

Benign tumor

Malignant tumor

Congenital cystic neck masses

Inflammatory cystic masses

Vascular cystic masses

Viscera saccular cysts

Parenchymal cysts

Benign cystic tumors

Malignant cystic tumors

Parotid space: Suprahyoid neck – Periparotid area

Posterior submandibular space: Angle of the mandible