4. Neck Lump Flashcards
What are differentials for a lateral neck lump?
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
Is a lateral neck lump in a child usually benign or malignant? What are the most common causes?
Benign
Congenital
Inflammatory
Is a lateral neck lump in an adult usually benign or malignant? What are the most common causes?
Malignant
Metastases
Lymphomas
What questions should you ask about a lump? (lateral or midline)
? How long has it been there
? Change in size
? Painful
? Other lumps
What other symptoms should you ask about in a patient with a lateral neck lump? What should you ask about the symptoms?
Infection: Malaise, Fever, Rigors
Cancer: Weight loss, Fever, Night sweats
? Time course
What aspects of the history apart from symptoms suggest and infective or malignant causes of a lateral neck lump?
Infection: recent infection (URTI), contact with someone with an infection, recent trauma, bites/ scratches
Malignancy: Previous cancer/ neck radiotherapy, FHx, smoker, high alcohol intake
What factors are important about the location of a lateral lump?
Superficial or deep?
Anterior or posterior triangle of the neck?
What is the relationship to muscle?
What features of a neck lump should be picked up on palpation?
Is it tender/ warm?
Is it solid/ fluctuant?
Is it pulsatile?
Is it mobile?
What does a hard lateral neck lump suggest?
Malignant lymph nodes
What does a rubbery lateral neck lump suggest?
Chronic inflammatory lymph nodes
What does a soft lateral neck lump suggest?
Acute inflammatory lymph nodes
What does a pulsatile neck lump suggest?
Subclavian or carotid aneurysm
What are 2 classes of differential for a midline neck lump?
Thyroid
Non thyroid
What are 7 symptoms of hyperthryoidism?
Irritability Nervousness Increased appetite but weight loss Diarrhoea Heat intolerance Palpitations Oligomenorrhoea
What are 4 symptoms of hypothyroidism?
Fatigue
Weight gain
Constipation
Cold intolerance
What 14 symptoms are suggestive of head or neck cancer?
Dysphonia Stridor Stertor Breathing difficulty Dysphagia Odynophagia Globus Cough Haemoptysis Otalgia Unilateral hearing loss Nasal discharge Epistaxis Lumps/ ulcers on head/ neck
What does a fluctuant neck lump suggest?
Branchial cysts
Pharyngeal pouches
Laryngoceles
Epidermal / dermoid cysts
List 7 differentials for a midline neck lump associated with the thyroid
Physiological goitre Multinodular goitre Graves disease Hashimoto's thyroiditis Thyroglossal / thyroid cyst Solitary adenoma Carcinoma
List 5 differentials for a midline neck lump not associated with the thyroid
Lipoma Dermoid cyst Epidermal cyst Abscess Lymphoma
What associated symptoms should be asked about a midline neck lump?
Symptoms of hyper-/ hypothyroidism
Symptoms of compression/ invasion e.g. dyspnoea, dysphagia, change in voice
Symptoms of infection
What should be considered in the PMH of a patient with a midline neck lump?
AI disorders
Risk factors for thyroid malignancy e.g. radiation to neck
What should be considered in the FHx of a patient with a midline neck lump?
AI disease
Hereditary forms of thyroid carcinoma
What is suggested from the location of a midline lump?
Superficial: Lipoma, cyst, abscess
Deep: Thyroid
What is suggested by the relationship of a midline lump to other structures?
Moves on swallowing: Thyroid
Moves on tongue protrusion: Thyroglossal cyst
Tethered to muscle/ skin: Malignancy
What is suggested from the character of a midline lump?
Diffuse, smooth enlargement: Physiological, Graves’, Hashimotos
Solitary, solid: Malignancy
Solitary, cystic: Cysts
Multinodular: Multinodular goitre
What else should be examined closely on inspection of a midline lump?
? Cervical lymphadenopathy
? Extent of thyroid swelling
? Signs of hyper-/ hypothyroidism
