Working Diagnosis:
Complex fluid mass formation at medial-third of the right supraclavicular space

Treatment:
The patient consented to surgical exploration of the mass with hardware removal from the right clavicle, based on imaging and work up. Case Photo #5 Case Photo #6

Outcome:
At the initial post-operative (six days) follow-up appointment, the patient had some mild neck swelling but no distinct cystic mass was noted. No erythema or paresthesias were present. Full active range-of-motion was present in neck and bilateral shoulders.

A pathology report of the surgically removed mass was consistent with a pseudocyst formation without malignant or atypical features.

RETURN TO PLAY:

At the six-week post-operative visit, the patient was instructed to begin wall pushups. At eight weeks, he progressed to table pushups, then floor pushups by week ten.

The patient was kept from tumbling for four months and avoided having anyone stand on his shoulders during this same time. At the fourth postoperative month, he began a gradual return to tumbling and was cleared for full activity.

Editor's Comments:
Primary care sports physicians see various types of soft tissue masses in all locations on the body. It is important to maintain a broad differential diagnosis when considering evaluation and treatment. In addition to the usual infectious causes, post-surgical complications need to be considered when masses arise in locations near prior surgical sites.

References:
1) Roshong-Denk SL, Bohman SL, Booth RL. A 53-Year-Old White Man with Right-Sided Supraclavicular Lymphadenopathy. Arch Pathology & Laboratory Medicine. (2005), 129 (7): 945-946.

2) Waseem M, Devas G, Perales O. A Child With Palpable Supraclavicular Node. Pediatric Emergency Care. (2006), 22 (1): 55-58.

3) Iynen I, Sogut O, Guldur ME, et al. Primary Hydatid Cyst: An Unusual Cause of a Mass in the Supraclavicular Region of the Neck. Journal of Clinical Medicine Research. (2001), 3 (1): 52-54.

4) Celik A, Turanli M, Kutun S, et al. Unusual location of hydatid cyst: soft tissue mass in the neck. European Archives of Oto-Rhino-Laryngology. (2006), 263 (12): 1147 – 1150.

5) Wang YA, Zhang ZY, Zheng JW, et al. Spontaneous thoracic duct cyst presenting as a left supraclavicular mass – report of a case and review of literature. Phlebology. (2009), 24(2): 82-84.

Return To The Case Studies List.