4. Neck Lump

Question 1

What are differentials for a lateral neck lump?

Answer 1

artery- carotid artery aneurysm, subclavian artery aneurysm, carotid body tumour
nerves- neurfibroma, schwannoma
Lymphatics- lymphatic malformations
lymph nodes- infective, neoplastic
salivary glands- infective, autoimmune, neoplastic
Larynx- laryngocele
Pharynx- pharyngeal pouch
Branchial arch remnant
Skin- lipoma, epidermal cyst, abscess, dermoid cyst
Muscle/ cartilage/ bone- sarcomas, cervical rib, torticollis

Question 2

Is a lateral neck lump in a child usually benign or malignant?

Answer 2

Benign

Question 3

Is a lateral neck lump in an adult usually benign or malignant?

Answer 3

Malignant

Question 4

What questions should you ask about a lump?

Answer 4

How long has it been there, has the lump changed in size, is the lump painful, are there any other lumps

Question 5

What other symptoms should you ask about in a patient with a lateral neck lump?

Answer 5

Symptoms suggestive of infection and head/ neck cancer

Question 6

What aspects of the history apart from symptoms suggest and infective or malignant causes of a lateral neck lump?

Answer 6

Infection- recent infection (URTI), contact with someone with an infection, recent trauma

Malignancy- Previous cancer, family hx of cancer, smoker, high alcohol intake

Question 7

What factors are important about the location of the lump?

Answer 7

Is it superficial or deep?
Is it in the anterior or posterior triangle of the neck?
What is the relationship to muscle?

Question 8

What features of a neck lump should be picked up on palpation?

Answer 8

Is it tender/ warm?
Is it solid/ fluctuant?
Is it pulsatile?
Is it mobile?

Question 9

What does a hard lateral neck lump suggest?

Answer 9

Malignant lymph nodes

Question 10

What does a rubbery lateral neck lump suggest?

Answer 10

Chronic inflammatory lymph nodes

Question 11

What does a soft lateral neck lump suggest?

Answer 11

Acute inflammatory lymph nodes

Question 12

What does a pulsatile neck lump suggest?

Answer 12

Subclavian or carotid aneurysm

Question 13

What are differentials for a midline neck lump?

Answer 13

Thyroid: physiological goitre, multinodular goitre, graves disease, hashimoto’s thyroiditis, thyroglossal cyst, solitary adenoma, carcinoma

Non thyroid- lipoma, dermoid cyst, epidermal cyst, abscess, lymphoma

Question 14

What are symptoms of hyperthryoidism?

Answer 14

Irritability, nervousness, increased appetite but weight loss, diarrhoea, heat intolerance, palpitations, oligomenorrhoea

Question 15

What are symptoms of hypothyroidism?

Answer 15

fatigue, weight gain, constipation, cold intolerance