2 Cervical Lymph Nodes and Neck Lumps

Question 1

What are the main functions of the lymphatic system?

Answer 1

1. Remove excess fluid from interstitial space
2. Immune defence- source of lymphocytes
3. Returns small proteins and fluid leaked from capillaries

Question 2

Name 3 regions in the body where collections of lymph nodes may be palpable.

Answer 2

• Neck (cervical)
• Armpit (axillary)
• Groin (femoral)

Question 3

What are the 2 main causes of lymphadenopathy?

Answer 3

• Infection
• Malignancy

Question 4

If a patient presents with lymphadenopathy, what action should you take?

Answer 4

1. Take comprehensive history
2. Examine area of tissue it drains
3. If systemic disease/malignancy suspected, examine other lymph nodes and body systems

Question 5

Where would you find deep cervical lymph nodes?

Answer 5

In carotid sheath mainly

(Some superficial nodes drain to other superficial nodes then to deep)

Question 6

Fill in the missing labels in the following image for the superficial lymph nodes draining the face scalp and neck:

Answer 6

Question 7

The Posterior cervical and Anterior cervical superficial nodes can be found on the anterior and posterior border of which muscle? What veins (venous routes) are they associated with?

Answer 7

Sternocleidomastoid

Superficial nodes in neck= associated with External jugular vein or Anterior jugular vein

Question 8

Conjunctivitis may cause node enlargement of which superficial cervical lymph node (remember which areas of the face drain to which nodes).

Answer 8

• Pre-auricular node enlargement

Question 9

Which lymph nodes will drain the tongue?

Answer 9

• Submental
• Submandibular

Question 10

Deep cervical lymph nodes are found deep to which muscle?

Answer 10

SCM

(Lymph nodes= closely related to IJV and carotid sheath)

Question 11

Label deep lymph nodes 9, 10 and 11:

Answer 11

Question 12

Name an example of a structure in the neck which drains directly into the deep cervical lymph nodes:

Answer 12

• Thyroid
• Posterior tongue

Question 13

Cancers inside the chest can cause which deep lymph node to enlarge?

Answer 13

Supraclavicular lymph nodes

Question 14

For each of the following images- identify the pathology and which lymph nodes may be enlarged.

Answer 14

Question 15

What is Waldeyer’s ring?

Answer 15

Annular collection of lymphoid tissue surrounding the upper aerodigestive

Question 16

Fill in the missing tonsil labels:

Answer 16

Question 17

If a patient presents with a neck lump, what history should be considered?

Answer 17

1. Age (children- likely to be infection)
2. Duration
3. Progression
4. Associated signs/symtoms

Question 18

What factors should be considered when examining a neck lump on a patient?

Answer 18

• Relation to location of underlying structures
• Anterior or posterior triangle, midline/lateral
• Movement with swallowing and stickng out tongue
• Palpation:
  
  • Superficial, mobile or deep
  • Hard, soft, smooth, irregular
  • Fixed to surrounding tissue
  • Tender/inflamed/painful?
  • Overlying skin changes

Question 19

Name some possible causes of neck lumps.

Answer 19

Question 20

For each of the areas circled - what could be the pathology?

Answer 20

Question 21

What are some red flags for lymphadenopathy? (presenting as neck lump)

Answer 21

• Persiting > 6 weeks
• Rapidly growing
• Fixed, hard, irregular
• Associated systemic signs
  
  • weightloss & night sweats - lymphoma/TB
• Associated persistent (unexplained) change in voice/ difficulty swallowing

Question 22

What is typically the first line imaging choice when investigating a neck lump?

Answer 22

Ultrasound