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MIDS 227 (neck + breast) > Ch 7 Neck Masses + Lymph Nodes > Flashcards

Ch 7 Neck Masses + Lymph Nodes Flashcards

1
Q

List 3 developmental neck cysts?

A

-Thyroglossal duct cyst
-Branchial cleft cyst
-Cystic hygroma

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2
Q

What is the m/c congenital neck cyst?

A

Thyroglossal duct cyst (at the infrahyoid level)

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3
Q

Where are thyroglossal duct cysts?

A

-They develop within the remnant of the thyroglossal duct
-Typically located midline, anywhere from the base of the tongue to the thyroid isthmus
-M/c location is at the infrahyoid level

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4
Q

Thyroglossal duct cysts occur m/c in older or younger pt’s?

A

Pediatric pt’s (0-10yrs)

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5
Q

What is the clinical presentation of thyroglossal duct cysts?

A

-Palpable/visible mass on neck
-Dysphagia (difficulty swallowing)
-Pain

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6
Q

Treatment for thyroglossal duct cysts?

A

Surgery

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7
Q

SF of thyroglossal duct cysts?

A

-M/c a midline cystic structure (medial to strap muscles)
-Anechoic, internal echoes or complex (often due to infection)
-Typically <3cm

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8
Q

What is the embryonic development of branchial clefts?

A

-Neck forms from a tube with 4 arches
-Arches develop into head + neck structures
-Pouches are located on the medial (pharynx) side + form the middle ear, tonsils, thymus + parathyroid glands
-Clefts are located b/w arches on the lateral side

(focus on clefts, not pouches)

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9
Q

What do the 4 branchial clefts develop into?

A

1st: develops into the external auditory canal

2nd-4th: merges to form the cervical sinus, which then obliterates + disappears

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10
Q

List 3 branchial cleft anomalies?

A

Cysts (m/c): no internal or external communication

Fistula: communicates internally + externally
(b/w pharynx + skin, pt may have fluid leaking from skin on the lateral side of neck)

Sinus: incomplete tract
(similar to a fistula, but is closed on 1 end)

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11
Q

Why do people get branchial cleft anomalies?

A

B/c there is incomplete obliteration of the cervical sinus

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12
Q

What causes branchial cleft cysts?

A

-Incomplete obliteration of clefts
-Congenital

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13
Q

Where are the 4 branchial cleft cysts located?

A

1st: identified on CT either in the auditory canal (type 1) or submandibular area (type 2)

2nd (m/c): along the anterior border of the upper third part of the SCM muscle or adjacent to it

3rd: rare + deep to SCM

4th: rare + variable location

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14
Q

What are branchial cleft cysts?

A

Lateral neck masses

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15
Q

Clinical presentation of branchial cleft cysts?

A

-Palpable neck mass
-Tender with infection

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16
Q

Treatment of branchial cleft cysts?

A

-Antibiotics (to treat infection)
-Surgery

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17
Q

What is a differential diagnosis for branchial cleft cysts?

A

Other benign cystic lateral neck masses, such as abscesses + necrotic adenopathy/lymph nodes

18
Q

SF of branchial cleft cysts?

A

Is variable:
-m/c anechoic
-homogeneous + hypoechoic with internal debris
-heterogeneous
-pseudosolid (l/c)

19
Q

What are cystic hygromas due to?

A

-Congenial
-Due to damage or an error in development of the cervical lymphatic system
-Associated with chromosomal abnormalities (such as turner syndrome, trisomy 21 + 18)

20
Q

M/c location of a cystic hygroma?

A

Occipital region

(back of neck or on lateral sides of neck)

21
Q

SF of cystic hygromas?

A

Multi-loculated, septated, cystic mass at the posterior + lateral side of neck

22
Q

List other neck pathology?

A

-Deep neck space infections
-Hematomas
-Cervical lymphadenopathy

23
Q

What are deep neck spaces referring to?

A

The compartments created by facial layers in the neck

(it does not mean deep in the body)

24
Q

What can deep neck space infections progress into?

A

-Inflammation/phlegmon or an abscess
-They are uncommon but serious as they have high morbidity + mortality risks

(phlegmon = a localized area of acute inflammation in the soft tissues, can progress into an abscess if not treated)

25
Q

What causes deep neck space infections in adults + children?

A

Adults: from dental work (odontogenic)
Children: tonsillitis
Other: infection, drugs, post-procedure, trauma, unknown, etc.

26
Q

What are the 3 m/c spaces for deep neck space infection abscesses to occur?

A

-Submandibular space
-Retropharyngeal space
-Parapharyngeal space

27
Q

Clinical presentation of deep neck space infections?

A

-History of recent dental procedure, recent other infection (such as upper respiratory tract infection) + neck/mouth trauma (surgery or biopsy)

-Pain

-Difficulty swallowing

28
Q

What is the gold standard for diagnosing deep neck space infections?

A

CT

29
Q

What is ultrasound + MRIs role in diagnosing deep neck space infections?

A

U/s:
-distinguishes phlegmon from an abscess
-evaluates relation to other anatomy
-m/c 1st step before moving to other imaging modalities (b/c is cheaper + has no radiation)

MRI:
-high resolution for assessing the extent (but is more costly + timely)

30
Q

SF of deep neck space infections?

A

Is variable
-Abscess appears fluid filled, thick walled + may have air within the collection (due to gas forming bacteria)
-Enlarged + reactive lymph nodes in the adjacent areas

31
Q

Treatment for deep neck space infections?

A

Differs for abscess vs phlegmon
-Typically antibiotics
-Sometimes surgery

32
Q

When would a hematoma occur?

A

Following trauma or surgery

33
Q

SF of a hematoma?

A

-Similar to an abscess, so we must obtain a clinical history
-Depends on the degree of coagulation as it may be cystic, solid or mixed structures

34
Q

Where are normal lymph nodes located?

A

-Throughout the cervical chain
-Easily seen in the submandibular, parotid, upper cervical + posterior triangle regions

(level 2a, 2b, 3, 5a + 5b)

35
Q

Are lymph nodes harder to see in younger or older pt’s?

A

Older

36
Q

What is a common site for metastases, lymphoma, lymphadenitis, TB + reactive hyperplasia?

A

Lymph nodes

37
Q

Discuss how u/s, CT + MRI are at imaging lymph nodes?

A

U/s (gold standard):
-Highly sensitive for small nodes (as small as 2mm) + intranodal calcifications
-Is preferred for identifying metastatic nodes from thyroid cancers

CT:
-Less sensitive than u/s for small nodes

MRI:
-Less sensitive for detecting calcifications within nodes

38
Q

SF of normal lymph nodes?

A

-Oval (can be round depending on location)

-Hypoechoic cortex (compared to adjacent soft tissue)

-Echogenic fatty hilum

-Hilar vascularity (hard to appreciate in small nodes <5mm)

-Size (m/c 10mm in short axis (AP), but varies with protocols)

39
Q

Is lymph node size reliable as a sole criteria for lymphadenopathy?

A

No! It can be helpful in serial studies tho

40
Q

What is lymphadenopathy?

A

Swelling of lymph nodes

41
Q

3 common causes of lymphadenopathy?

A

-Infection
-Autoimmune
-Neoplastic

42
Q

SF of lymphadenopathy?

A

-Round/bulging
-Hypoechoic
-Absent fatty hilum
-Cystic necrosis within
-Enlarged (on serial exams + with mets)
-Mixed/chaotic vascularity
-Mets from PTC (papillary thyroid cancer), calcifications in the nodes is common + lymph nodes will appear hyperechoic

MIDS 227 (neck + breast) (14 decks)

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