Part of “CHAPTER 38 – NONTOXIC GOITER“

The thyroidal origin of neck masses is usually apparent from their location and their movement with the thyroid gland on deglutition. Previous neck surgery, obesity, and hypertrophied bellies of sternocleidomastoid muscles can obscure the thyroidal nature of neck masses. Included in the differential diagnosis of neck lesions are branchial cleft cyst and thyroglossal duct cyst (Fig. 38-3). Branchial cleft cysts are anterolateral, whereas thyroglossal duct cysts are midline and are found at any point between the isthmus and the area above the laryngeal prominence (cartilage). When thyroglossal duct cysts remain contiguous with the base of the tongue (foramen caecum linguae), they move upward with voluntary protrusion of the tongue. Cystic hygroma (diffuse, fluid-filled, multiloculated lymphangioma that is present at birth) arises from the supraclavicular fossa and should not be confused with goiter.