Cervical Lymph Nodes and Neck Lumps Flashcards
Cervical lymphadenopathy is a common cause of neck lumps.
What are 2 causes?
- Recent infection/ inflammation
- Malignancy (Cancer)
Differentiate between how enlarged lymph nodes would feel on palpation if caused by;
Cancer
Infection
Lymphoma
Infection- Tender, mobile
Cancer- Hard, matted, non tender
Lymphoma- Rubbery, non tender, mobile, rapid growth
What are 4 aspects of a patients history that can help us determine the cause of a neck lump?
- Age (In children, lymphadenopathy is likely due to infection)
- Duration
- Progression
- Associated symptoms/ signs (including red flags)
Name 3 Midline neck lump causes
Name 2 Lateral neck lump causes
- Dermoid cyst (Congenital)
- Thyroglossal Duct Cyst (Congenital)
- Thyroid gland pathology
- Branchial cyst (Congenital, fluid filled, may transilluminate)
- Submandibular gland pathology (Cancer/ blockage)
*Congenital cysts may not appear in childhood
A dermoid cyst does not move on swallowing/ tongue protruding.
A Thyroglossal Duct Cyst or any Thyroid gland pathology related lump will move on swallowing.
A thyroglossal duct cyst will also move on tongue protrusion, Thyroid gland pathology will not.
Why is this?
The thyroglossal duct is still connected to a remnant of the tongue
List 6 Red Flags for Lymphadenopathy which indicate concerning underlying pathology
- Persisting >6 weeks
- Fixed, Hard and Irregular
- Rapid growth
- Generalised lymphadenopathy (E.g. HIV/ Lymphoma
- Systemic signs such as weight loss/ night sweats (E.g Lymphoma, Cancer)
- Persistent change in voice or difficulty swallowing (Could be cancer)
List 3 functions of Lymphatic system
How many lymph nodes in body? How many in neck?
- Remove excess fluid from interstitial space
- Immune defence (Physical and phagocytic filter)
- Returns small proteins and fluid back to blood after leak from capillaries
800, 300 in neck
What 3 steps do you take if a lymph node is found to be enlarged?
- Take comprehensive history
- Examine the area of tissue it drains
- Examine other nodes and body systems if cancer/ systemic disease is suspected
Compare the location of the 2 groups of lymph nodes
Regional/ Superificial: Within Superficial Cervical Fascia (Palpable)
Terminal/ Deep/ Deep Cervical Nodes : Deep to Investing Layer (Many in carotid sheath, associated with IJV)
Compare the regions drained by Regional and Terminal Lymph nodes
Regional: Drain specific areas
Terminal: Drain all lymph from head and neck, including from Regional nodes
(Structures deep to Investing Layer will drain directly to Terminal nodes)
Name the 5 Superficial Lymph nodes in the head
- Sub-mental (Below chin)
- Sub-mandibular (Below mandible angle)
- Pre-auricular (front of ear)
- Post-auricular
- Occipital (Back of head)
Name the 3 Superficial Lymph nodes in the neck
- Superficial Cervical
- Anterior (Front of SCM, associated with Ant. Jugular Vein)
- Posterior (Behind SCM, associated with IVJ
Name 3 Terminal/ Deep Cervical Lymph Nodes
What are they deep in reference to?
- Jugulo-digastric (Close to post. belly of Digastric)
- Jugulo-omohyoid
- Supraclavicular (within Supraclavicular fossa)
In reference to SCM Muscle
What 3 regions are drained by the Jugulo-digastric lymph node (Terminal)
What is this node also called?
- Tongue
- Pharyngeal tonsils
- Oral cavity
Also called the Tonsillar node (Often swollen in in Tonsillitis and enlarges in cancers affecting the structures it drains)
What 5 regions are drained by the Jugulo-omohyoid lymph node
- Tongue
- Trachea
- Oral cavity
- Thyroid gland
- Oesophagus
The Supra-Clavicular nodes are found in the base of what triangle?
What 2 regions do they drain?
Posterior triangle
Parts of abdomen and thorax
Can neck lumps be caused by salivary gland pathology
Yes
What is Waldeyer’s Ring?
List the tonsils that make up the ring from back to front of mouth
An annular collection of lymphoid tissue surrounding the upper aerodigestive tract
1 Pharyngeal tonsil
2 Tubal tonsils (Smallest)
2 Palatine tonsils
Lingual tonsils
Which tonsils are affected by Tonsillitis
Palatine tonsils
Which tonsils are also called Adenoids
Pharyngeal tonsils
Which tonsils are most easily visible on examination of a patient
Palatine (at the side)
Why might Adenoid (Pharyngeal tonsil) enlargement cause middle ear problems?
Give 3 reasons
- Can block Eustachian tube
- Mucus can’t drain properly and accumulates
- Infection easily spreads into middle ear
