On the right side of a 36-year-old woman's neck was a firm, moderately painful mass. When she rotated her head to the right, the pain worsened. The mass had been present for several years, but it had not bothered the patient until recently. She denied any numbness or weakness in her upper limbs. There was no history of trauma, weight loss, night sweats, fever, or chills. Physical examination revealed an asymmetric, slightly tender, and hard 2-cm mass in the right supra-clavicular area. There was no palpa ble thyroid mass. She had decreased range of motion because of the pain. An examination of the ears, nose, mouth, and throat, as well as the upper extremities (including neurologic and vascular systems), was unrernarkable. There was no lymph-adenopathy in the patient's neck.
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