Cervical lymph nodes and neck lumps Flashcards
What are the functions of the lymphatic system?
Remove excess fluid from interstitial space
Return small proteins (inc pathogens) and fluid that leaked from capillaries
Key role in immune defence and immune surveillance
-Physical and phagocytic barrier
-Source of lymphocytes
What are some clinical manifestations of disease involving the lymphatic system?
Lymphoedema
Lymphadenoathy: swollen lymph nodes due to infection or malignancy
Each node has a number of affrent (input) and only one output (efferent). What effect does this have on lymph?
Slows down so time to filter. There is a:
- Physical filter
- Phagocytic filter
- Lymphocytes (T&B) which active and proliferate in response to antigens.
What specific regions are there where lymph nodes are palpable?
Neck (over half)
Armpit
Groin
If a lymph node feels tender and mobile, what is it likely to be?
An Infection
If a lymph node feels hard, matted and non tender, what is it likely to be?
Malignant
If a lymph node feels rubbery, mobile and fast growing, what is it likely to be?
Lymphoma
What do you do if a lymph node is found to be enlarged?
- Do a comprehensive astray
- Examine the area of tissue it drains
- If systemic disease or malignancy is suspected then you examine other lymph nodes and body systems.
Where do you find superficial lymph nodes?
Superficial cervical fascia
What is superficial cervical fascia continuous with?
Face
Where are deep lymph nodes mainly located?
The route of the IJV in carotid sheath, in the neck.
They are deep to the SCM
Label these lymph nodes 1-8
All pic
Where do the lymph nodes drain?
Add pic
What are the three key deep cervical lymph nodes?
Jugulo-digastric (drains tonsils)
Jugulo-omahyoid (drains posterior tongue and larynx)
Supraclavicular lymph nodes (drains chest and abdomen - so could have stomach / bowel cancer act..)
Label deel cervical lymph nodes
ddd
What tonsils are in walkdeyers ring?
Pharyngeal tonsils
Palantine tonsils (ones you can see)
Lingual tonsils
Tubal tonsils
If a patient has a neck lump, what do you Ask in the history?
Age - children more likely to be infection
Duration
Progression
Associated symptoms / signs (inc red flags - weight loss / night sweats)
If a patient has a neck lump, what do you look for in examination?
Location (compared to underlying structures)
Anterior / Posterior triangle, midline / laterally placed
Movement with swallowing and sticking tongue out
Palpation features =
-Superficial / Deep
-Hard/soft/smooth/irregular
-Fixed to surrounding tissue?
-Tender
-Overlying skin changed
Causes of superficial neck lump?
Sebaceous cyst
Dermoid cyst
Lipoma
Skin abcess
Inflammatory causes of neck lump
Tonsilitis
Mouth ulcer
Congenital causes of lymph nodes
Thyroglossal cyst
Brachial cyst
Laryngocoele
Pharyngeal pouch
Malignant causes of neck lumps
Primary or secondary
Supraclavicular LNs drain into thorax / abdomen too
Salivary gland pathology causes of neck lumps
Calculus
Infection
Tumour
Other causes of neck lump
Chronic infection
Carotid artery
Aneurysm
What neck lumps lie on the midline?
Dermoid cyst
Thyroglossal duct cyst
What neck lumps lie laterally?
Submandibular gland - inflamed or malignant
Brachial cyst
What are the red flags for lymphadenopathy?
- Persistent - Over 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
