 The American Academy of Otolaryngology-Head and Neck Surgery recently created clinical guidelines for the evaluation of a neck mass in adults [14], emphasizing the importance of timely diagnosis. They issued a strong recommendation for contrast-enhanced neck CT or contrast-enhanced neck MRI for patients with a neck mass deemed at risk for malignancy. In their treatment flow chart, imaging was considered in parallel with fine-needle aspiration of the palpable mass or node for timing of diagnostic evaluation. Ultrasound (US) was considered an option for initial imaging in suspected thyroid or salivary masses or as an adjunct to expedite sampling. Discussion of Procedures by Variant Variant 1: Nonpulsatile neck mass(es). Not parotid region or thyroid. Initial imaging. Cross-sectional imaging with CT or MRI allows for precise localization of the palpable finding. Both CT and MRI can accurately assess tumors and inflammation, and CT and MRI are considered equally effective studies for clinical oncologic evaluation [14,19]. Intravenous (IV) contrast is essential for detecting neck abscesses, especially those that are intramuscular [20-22]. Contrast-enhanced imaging is helpful for identifying nodal necrosis and can help guide the search for primary tumor [23,24]. Contrast also helps to clarify primary tumor within the upper aerodigestive tract and the relationship of neck masses to the major vessels of the neck. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Neck Mass/Adenopathy
Neck Mass Adenopathy.  The American Academy of Otolaryngology-Head and Neck Surgery recently created clinical guidelines for the evaluation of a neck mass in adults [14], emphasizing the importance of timely diagnosis. They issued a strong recommendation for contrast-enhanced neck CT or contrast-enhanced neck MRI for patients with a neck mass deemed at risk for malignancy. In their treatment flow chart, imaging was considered in parallel with fine-needle aspiration of the palpable mass or node for timing of diagnostic evaluation. Ultrasound (US) was considered an option for initial imaging in suspected thyroid or salivary masses or as an adjunct to expedite sampling. Discussion of Procedures by Variant Variant 1: Nonpulsatile neck mass(es). Not parotid region or thyroid. Initial imaging. Cross-sectional imaging with CT or MRI allows for precise localization of the palpable finding. Both CT and MRI can accurately assess tumors and inflammation, and CT and MRI are considered equally effective studies for clinical oncologic evaluation [14,19]. Intravenous (IV) contrast is essential for detecting neck abscesses, especially those that are intramuscular [20-22]. Contrast-enhanced imaging is helpful for identifying nodal necrosis and can help guide the search for primary tumor [23,24]. Contrast also helps to clarify primary tumor within the upper aerodigestive tract and the relationship of neck masses to the major vessels of the neck. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Neck Mass/Adenopathy