2. Cervical Lymph Nodes and Neck Lumps. Flashcards
What are the functions of the lymphatic system?
• Remove excess fluid from interstitial space
• Returns small proteins (inc. pathogens) and fluid that leaked from capillaries
• Key role in immune defence and surveillance
- Physical and phagocytic barrier
- Source of lymphocytes
What are the main causes of Clinical manifestations of disease involving the lymphatic system?
– Lymphoedema
– Lymphadenopathy: swollen lymph node(s) due to infection or malignancy (primary and secondary)
In infections, why do the lymph nodes swell?
lymphocytes Activate and proliferate in response to antigens
How many lymph nodes do All substances transported in lymph travel through?
• All substances transported in lymph pass through ≥ 1 lymph node
In which regions of the body are lymph nodes mainly found in?
- neck
- armpit
- groin
Where are most of the lymph nodes found?
Nearly ½ of all the body’s lymph nodes are found in the neck
What aspect of lymph nodes slows the flow of lymph?
many afferent vessels but single efferent vessel - allows lymph node to filter and react to any antigens
What are the characteristics of enlarged lymph nodes in lymphadenopathy caused by infection?
Tender, mobile
What are the characteristics of lymph nodes in lymphadenopathy caused by malignancy?
Hard, matted, non-tender,
rubbery, mobile, fast growing
If lymph node is found to be enlarged what needs to be done?
- Comprehensive history
- Examine the area of tissue it drains
- If systemic disease/malignancy suspected examine other lymph nodes and body systems
Where are the superficial and deep lymph nodes in the neck found?
Superficial within the superficial fascia.
Deep lymph nodes deep to the investing layer of fascia (and deep to SCM).
Where are many of the deep lymph nodes in the neck found?
Associated with the route of the IJV in the carotid sheath
Which lymph nodes do the superficial lymph nodes of the neck drain into to?
The deep lymph nodes of the neck
Where do structures invested within the investing layer of fascia drain into?
Deep lymph nodes of the neck
Which type of lymph node is more readily palpable?
superficial
What are the superficial lymph nodes of the neck and where are they found?
superficial cervical (superficial to SCM), anterior cervical (anterior triangle) and posterior cervical (posterior triangle)
Which structures are the superficial lymph nodes of the neck associated with?
EJV or AJV
What are the superficial lymph nodes draining face and scalp?
1) submental lymph nodes
2) submandibular lymph nodes
3) pre auricular lymph nodes
4) post-auricular lymph nodes
5) occipital lymph nodes
what does the superficial lymph nodes draining the face and scalp drain into?
deep lymph nodes in the neck
Which lymph nodes are most likely to swell in conjunctivitis?
Preauricular
What are the deep lymph nodes of the neck?
Jugulo-digastric, jugulo-omohyoid, supraclavicular
Which lymph nodes swell in tonsillitis?
Jugulodigastric
Which lymph nodes drain which part of the tongue?
Anterior = Submental, middle = submandibular, posterior = directly to deep lymph nodes
Where is the supraclavicular lymph nodes found and which part of the body do they drain?
In the supraclavicular fossa in the posterior triangle. Drain chest and abdomen
which lymph node is affected if mouth ulcer on inner surface of lower lip?
submental
what needs to be examined if lump below mandible of chin?
inside mouth
which lymph node is affected if mouth ulcer on tip of tongue?
submental
in tonsilitis, why does the neck need to be palpated?
as they drain into deep cervical lymph nodes - jugular digastric
What structures make up Waldeyer’s ring
Pharyngeal (adenoid) tonsil (top), tubal tonsils, palatine tonsils, lingual tonsil
Which lymph nodes do palatine tonsils drain to?
Jugulodigastric lymph nodes
Which lymph nodes do pharyngeal tonsil drain to?
Upper deep cervical and retropharyngeal lymph nodes
What other symptoms can an enlarged pharyngeal tonsil present with in children?
middle ear complications as the eustachian tube can be compressed
nasal onstruction
What is the most likely cause of lymphadenopathy in children?
Secondary to infection
What are 4 things to ask as part of history when considering neck lumps?
age, Duration, progression, associated symptoms/signs
What is important to note in examination of neck lumps?
• Anterior or posterior triangle? Midline or laterally placed?
• Movement with swallowing and sticking out tongue?
• Palpation features
o Does it feel superficial, just beneath skin and quite mobile… or deeper?
o Hard/soft/ smooth/irregular
o Fixed to surrounding tissue?
o Tender (inflamed/infected lumps likely painful)?
o Overlying skin changes e.g. red
vWhy is it important to note if neck lumps are tender?
Inflamed or infected lumps likely painful.
What are possible causes of neck lumps?
- Inflammatory/ Infective lymph node
- Congenital lesions
- Thyroid pathology
- Primary (e.g. lymphoma) or secondary malignant (metastatic) disease involving a lymph node
- Salivary gland pathology`
Give examples of superficial neck lumps.
Sebaceous cysts, dermoid cysts, lipoma, skin abscess.
What is a dermoid cyst?
congenital defect - occurs dung embryonic development when skin layers don’t properly grow together - cyst line with epithelium become filled with fluid from glands
Give examples of inflammatory/infective neck lumps.
Tonsillitis, mouth ulcer
Give examples of congential neck lumps.
Thyroglossal cysts, branchial cysts, laryngocoele, pharyngeal pouch
Give examples of thyroid neck lumps.
Malignant or benign neoplasia
Give examples of neoplastic neck lumps.
Primary - Lymphoma or secondary malignant - (supraclavicular LN drain thorax and abdomen too)
Give examples of salivary gland neck lumps.
Calculus, infection, tumour
give examples of other neck lumps
chronic infection (tuberculosis, HIV) can cause lymphadenopathy, carotid artery aneurysm
Give examples of neck lumps that occur in the midline in the anterior border.
Thyroglossal cyst, dermoid cyst, thyroid (goitre)
Give examples of neck lumps that occur laterally in the anterior border.
Branchial cyst, submandibular salivary gland
What are the characteristics of a dermoid cyst?
- Congenital,
- pea size,
- high in midline,
- in superficial fascia,
- doesn’t move on swallowing or tongue protrusion
- not painful to palpate
What are the characteristics of a thyroglossal duct cyst?
- Congenital,
- high in midline,
- persistence of duct attaching tongue to thyroid gland,
- moves on swallowing and sticking tongue out
What are the characteristics of a thyroid pathology?
- Low in midline,
* moves on swallowing
What are the characteristics of a branchial cyst?
- Congenital,
- high laterally,
- anterior border of the SCM
- fluctuance when palpated - fluid filled
- may transilluminate
- painful if become infected
- can become apparent after URT infection
What are the characteristics of a submandibular salivary gland lump?
High laterally, anterior border of the SCM
- cancer, blockage
what should be included as a potential cause when a lump anywhere in the neck?
lymphadenopathy
is lymphadenopathy a diagnosos?
no it is a sign of an underlying disease
What are the red flags for lymphadenopathy? (6)
• Persisting > 6 weeks
• Fixed, hard and irregular
• Rapidly growing in size
• Associated with generalised lymphadenopathy
• Associated systemic signs/symptoms such as weight loss,
night sweats
• Associated with a persistent (unexplained) change in
voice/hoarseness or difficulty swallowing
