Classic findings

Question 1

By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness

Answer 1

Reactive lymphadenopathy

Question 2

Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly

Answer 2

Lymphoma

Question 3

May be hypo-, eu- or hyperthyroid symptomatically

Moves upwards on swallowing

Answer 3

Thyroid swelling

Question 4

More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected

Answer 4

Thyroglossal cyst

Question 5

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough

Answer 5

Pharyngeal pouch

Question 6

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age

Answer 6

Cystic hygroma

Question 7

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood

Answer 7

Branchial cyst

Question 8

More common in adult females

Around 10% develop thoracic outlet syndrome

Answer 8

cervical rib

Question 9

Pulsatile lateral neck mass which doesn’t move on swallowing

Answer 9

Carotid aneurysm