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. <a href="CaseStudyImages/CS5CS4CS3CS2CS1Unila-123.jpg" title="Case Photo #5" data-lity><b>Case Photo #5</b></a> <a href="CaseStudyImages/CS6CS5CS4CS3CS2CS1Un-123.jpg" title="Case Photo #6" data-lity><b>Case Photo #6</b></a>

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. <br> <br>A pathology report of the surgically removed mass was consistent with a pseudocyst formation without malignant or atypical features. <br> <br>RETURN TO PLAY: <br> <br>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. <br> <br>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. <br> <br>2) Waseem M, Devas G, Perales O. A Child With Palpable Supraclavicular Node. Pediatric Emergency Care. (2006), 22 (1): 55-58. <br> <br>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. <br> <br>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. <br> <br>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.

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