26-Year-Old Female with Persistent Neck Mass and Health Anxiety

Case at a Glance

A 26-year-old female with a history of PCOS, lumbar herniated disc, and TMJ presented with a one-month history of a palpable neck mass and associated neurological symptoms.

Patient's Story

The patient discovered a hard, pea-sized lump behind her left neck near the hairline approximately one month prior to presentation. She reported no pain, growth, or visible changes to the mass. The patient has a significant history of health anxiety and frequent emergency department visits, which initially delayed her seeking medical attention. She also noted intermittent left arm numbness and finger tingling, though was uncertain if this was related to the neck mass or her known lumbar herniated disc. The patient recalled a recent TMJ flare-up several weeks prior, during which she experienced bilateral ear pain and what she believed were swollen lymph nodes, first on the right side, then the left.

Initial Assessment

Physical examination revealed a firm, non-tender, approximately 1cm mass in the left posterior cervical region near the hairline. The mass was non-mobile and located in the subcutaneous tissue. The patient appeared anxious but was otherwise in no acute distress. Her primary care physician initially provided reassurance without further investigation, which increased the patient's anxiety about potentially serious underlying pathology.

The Diagnostic Journey

Given the patient's persistent concerns and the clinical presentation of a firm neck mass, a second medical opinion was sought. The differential diagnosis included reactive lymphadenopathy, lipoma, sebaceous cyst, or less likely, malignant lymphadenopathy. The patient's history of recent TMJ flares with associated lymph node swelling suggested a possible reactive process.

Final Diagnosis

Further evaluation pending - requires imaging studies and possible biopsy for definitive diagnosis of the cervical mass.

Treatment Plan

1. Referral for neck ultrasound to characterize the mass
2. Consider CT or MRI if ultrasound findings are concerning
3. Dermatology consultation for evaluation of superficial neck lesion
4. Patient education regarding warning signs that warrant immediate medical attention
5. Anxiety management and reassurance regarding appropriate follow-up timeline

Outcome and Follow-up

Patient scheduled for diagnostic imaging and specialist consultation. Advised to monitor for changes in size, texture, or associated symptoms. Follow-up appointment scheduled in 2-4 weeks to review imaging results and determine next steps. Patient counseled on the importance of advocating for her health concerns while managing anxiety appropriately.