Adult Neck Masses Flashcards
an abnormal lesion, congenital or acquired that is visible, palpable, or seen on an imaging study below the mandible, above the clavicle and deep to the skin
neck mass
fluctuating in size = ___
persistently enlarging = ___
fluctuating = inflammatory or congenital
persistently enlarging = malignancy
age difference in ddxs
pedia: inflammatory, congenital > neoplasm
adult: neoplasm > inflammatory, congenital
t/f adult neck mass should be considered malignant unless proven otherwise
true
detailed examination of the mass
appearance borders consistency and color dimensions extent fixation
borders of anterior triangle
S inferior border of mandible L anterior border of the scm M sagittal line down the midline of the neck R investing fascia F visceral fascia
borders of carotid angle
S posterior belly of digastric muscle
L medial border of scm
I superior belly of omohyoid muscle
contents of carotid triangle
common carotid artery
internal jugular vein
hypoglossal nerve
vagus nerve
borders of submental triangle
I hyoid bone
M midline of neck
L anterior belly of digastric muscle
F mylohyoid muscle
contents of submental triangle
submental lymph nodes (filters lymph from floor of mouth and tongue)
borders of submandibular triangle
S body of mandible
A ant belly of digastric
P posterior belly of digastric
contents of submandibular triangle
submandibular gland and lymph nodes
facial artery and veins
borders of muscular triangle
S hyoid
M imaginary midline of neck
SL superior belly of omohyoid muscle
IL inferior portion of scm
contents of muscular triangle
infrahyoid muscle
pharynx
thyroid gland
parathyroid gland
most vital structures in ant triangle
thyroid gland
carotid and jugular
submandibular
lymphatics
borders of posterior triangle
A posterior border of scm
I middle 1/3 of clavicle
P ant border of trapezius
muscle that splits post triangle into 2 triangles
omohyoid muscle -> occupital triangle and subclavian triangle
level 1 of lymph
submental and submandibular
lip, oral cavity, skin of lower face
level 2 of lymph
upper jugular
oropharynx (tonsil and tongue)
parotid gland
level 3 of lymph
mid jugular
hypopharynx and thyroid gland
level 4 of lymph
supraclavicular
larynx, hypopharynx, thyroid, non-head or neck sits (lung, breast, gi, gu)
enlarged __ indicated abdominal malignancy
virchow’s node
level 5 of lymph
post triangle
scalp, lymphoma, nasopharynx
level 6 of lymph
paratracheal
thyroid and larynx
nasopharynx pe
e tube orifices, superior and posterior walls through nasal endoscopy
hypopharynx pe
pyriform sinuses and post pharyngeal wall
most frequently used modality for adults
ct scan (adults > pedia)
uts is more used in ___
pedia and thyroid nodules
can distinguish between solid and fluid filled masses
when to use mri
- most detailed anatomic soft tissue info
- best for salivary gland masses and determination of perineural extension
when to use mra/cta
vascular structures (vascular tumors)
what does pet scan do
- functional imaging
- bright spots = cells with higher metabolic rate
- detection and surveillance of h&n cancer
indications for pet scan
- detection of unknown primary tumor site
- tumor staging
- radiotherapy planning
- treatment response assessment
- detection of recurrent disease
initial method for obtaining pathologic tissue sample of neck mass
fna biopsy
t/f there is no need to prepare a cell block
false, lymphoma is always a concern so always prepare cell block
indications for fna
- single asymmetric node >1.5 cm
- persistent enlarged node without prior signs of active infection
- persistence after trial of antibiotics and observation >2-4 wks
- increasing size of mass
local s/sx for infection
- warmth
- erythema of overlying skin
- localized swelling
- tenderness to palpation
if (+) for infection ___
empiric broad spectrum antibiotic therapy (2 wks)
if (-) for infection ___
determine signs of increased risk for malignancy, don’t give antibiotics
increased risk for malignancy
- lack of hx of infectious etiology
- present >2 wks without significant fluctuation
- uncertain duration
- > 1 of ff:
fixation to adjacent tissues, firm consistency, size >1.5 cm, ulceration of overlying skin
other suspicious findings on hx and pe
read
when to refer
- mass does not resolve within 2-4 wks following antibiotics
- sus malignant
- mass with rapid enlargement w/ or w/o inflammation
- thyroid/ salivary mass
- fixed mass
indications for open biopsy
- > 2 cm and growing
- low cd4
- asymmetric, unilateral, or localized lymphadenopathy
- constitutional symptoms of unknown origin
- mediastinal adenopathy
- hepatosplenomegaly
t/f incision biopsy should be avoided for metastatic sq cell carcinoma
true, look for the primary tumor, refer to specialist
management
- surgical
- chemo for lymphoma
- tb meds for tb adenitis
- antibiotics for bacterial lymphadenitis
