4. Neck Lump

Question 1

What are differentials for a lateral neck lump?

Answer 1

Artery: carotid or subclavian artery aneurysm, carotid body tumour
Nerves: neurfibroma, schwannoma
Lymphatics: lymphatic malformations
Lymph nodes: infective, neoplastic, granulomatous
Salivary glands: infective, AI, 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? What are the most common causes?

Answer 2

Benign
Congenital
Inflammatory

Question 3

Is a lateral neck lump in an adult usually benign or malignant? What are the most common causes?

Answer 3

Malignant
Metastases
Lymphomas

Question 4

What questions should you ask about a lump? (lateral or midline)

Answer 4

? How long has it been there
? Change in size
? Painful
? Other lumps

Question 5

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

Answer 5

Infection: Malaise, Fever, Rigors
Cancer: Weight loss, Fever, Night sweats
? Time course

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, bites/ scratches

Malignancy: Previous cancer/ neck radiotherapy, FHx, smoker, high alcohol intake

Question 7

What factors are important about the location of a lateral lump?

Answer 7

Superficial or deep?
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 2 classes of differential for a midline neck lump?

Answer 13

Thyroid

Non thyroid

Question 14

What are 7 symptoms of hyperthryoidism?

Answer 14

Irritability
Nervousness
Increased appetite but weight loss
Diarrhoea
Heat intolerance
Palpitations
Oligomenorrhoea

Question 15

What are 4 symptoms of hypothyroidism?

Answer 15

Fatigue
Weight gain
Constipation
Cold intolerance

Question 16

What 14 symptoms are suggestive of head or neck cancer?

Answer 16

Dysphonia
Stridor
Stertor
Breathing difficulty
Dysphagia
Odynophagia
Globus
Cough
Haemoptysis
Otalgia
Unilateral hearing loss
Nasal discharge
Epistaxis
Lumps/ ulcers on head/ neck

Question 17

What does a fluctuant neck lump suggest?

Answer 17

Branchial cysts
Pharyngeal pouches
Laryngoceles
Epidermal / dermoid cysts

Question 18

List 7 differentials for a midline neck lump associated with the thyroid

Answer 18

Physiological goitre
Multinodular goitre
Graves disease
Hashimoto's thyroiditis
Thyroglossal / thyroid cyst
Solitary adenoma
Carcinoma

Question 19

List 5 differentials for a midline neck lump not associated with the thyroid

Answer 19

Lipoma
Dermoid cyst
Epidermal cyst
Abscess
Lymphoma

Question 20

What associated symptoms should be asked about a midline neck lump?

Answer 20

Symptoms of hyper-/ hypothyroidism
Symptoms of compression/ invasion e.g. dyspnoea, dysphagia, change in voice
Symptoms of infection

Question 21

What should be considered in the PMH of a patient with a midline neck lump?

Answer 21

AI disorders

Risk factors for thyroid malignancy e.g. radiation to neck

Question 22

What should be considered in the FHx of a patient with a midline neck lump?

Answer 22

AI disease

Hereditary forms of thyroid carcinoma

Question 23

What is suggested from the location of a midline lump?

Answer 23

Superficial: Lipoma, cyst, abscess
Deep: Thyroid

Question 24

What is suggested by the relationship of a midline lump to other structures?

Answer 24

Moves on swallowing: Thyroid
Moves on tongue protrusion: Thyroglossal cyst
Tethered to muscle/ skin: Malignancy

Question 25

What is suggested from the character of a midline lump?

Answer 25

Diffuse, smooth enlargement: Physiological, Graves’, Hashimotos
Solitary, solid: Malignancy
Solitary, cystic: Cysts
Multinodular: Multinodular goitre

Question 26

What else should be examined closely on inspection of a midline lump?

Answer 26

? Cervical lymphadenopathy
? Extent of thyroid swelling
? Signs of hyper-/ hypothyroidism