Face and Neck Flashcards
What is the key step when evaluating a patient with a new neck mass?
Thorough history
Why is the age of the patient a critical factor in the workup?
Majority of pediatric neck masses are inflammatory or congenital in origin; frequency of malignancy increases between ages 16 and 40; a neck mass in an adult over 40 should be considered neoplastic and malignant until proven otherwise.
When considering the growth patter of a mass what characteristics should be taken into account?
Duration, growth pattern, absence or presence of pain
- Masses that are present for years with little change are likely to be what?
- Rapidly expanding masses may be due to what disease processes?
- Masses that fluctuate over time and increase with viral illnesses or URIs are most likely what?
- Benign neioplasms
- Infectious processes or rapidly growing lymphomas
- Congenital cysts
What symptoms are typical of neck masses?
Pain, voice change, hoarseness, dysphagia, otalgia
What other ROS questions should be asked when evaluating these patients?
Presence of fever, night sweats or weight loss
What should a focused physical exam relating to a neck mass include?
All anatomical areas that may be relevant to the mass
What are the characteristics of neck masses due to “reactive” lymph nodes?
Discrete, mobile, firm or rubbery but not rick hard, slightly tender
What are the characteristics of a neck mass that raises concern for malignancy?
Rock-hard, fixed, matted to underlying structures, nontender
What are the characteristics of infected lymph nodes?
Isolated, asymmetric, tender, warm, erythematous, may be fluctuant
What are the characteristics of cystic congenital masses?
Soft, ballotable, mobile
What are the characteristics of a carotid body tumor or vagal schwannoma?
Firm, lateral mass which moves side-to-side but not up and down (suggests involvement with carotid sheath)
What is characteristic of a vascular lesion neck mass?
Pulsatile quality or bruit
What is characteristic of a mass on the thryroid such as a thyroglossal duct cyst or thryroid tumor?
Immobile midline neck mass which elevates with swallowing
What should be included on the PE?
Skin of the head and neck, cranial nerve function, thyroid gland, abdominal exam
Which labs should be considered for patients with neck masses?
CBC with diff ESR and/or CRP Blood culture (in febrile patients) EBV or CMV serology HIV serology in patients with increased risk
Which imaging studies are most useful when evaluating a neck mass?
US, CT w/contrast is initial study of choice
What is the most accurate and safe diagnostic study that should be done when evaluating a neck mass?
FNA
What other diagnostic study can be done?
Excisional or incisional biopsy
