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
