General Surgery_Neck Masses Flashcards
What is the greatest concern when an adult presents with a neck mass?
Malignancy (risk of malignancy increases with age)
What factors increase the likelihood of neck malignancy?
- Smoking
- heavy alcohol use
- history of radiation treatment
- chronic sun exposure
- family history
What is the most common site of neck masses?
Lymph nodes
What are the most common congenital neck masses of the lateral neck?
Brachial anomalies (cyst, sinus, fistula)
What is the most common type of branchial anomaly and how does it typically present?
- Second arch branchial cyst presenting in infants as a painless fluctuant mass in the anterior triangle
What is the most common congenital neck mass of the midline neck?
Thyroglossal duct cyst
What kind of malignancy has been reported within thyroglossal duct cysts?
Thyroid carcinoma
What signs and symptoms indicate that a neck mass is most likely due to an inflammatory process?
- Recent infection, fever, tenderness and erythema at site of mass, rapidly growing
Viruses, bacteria, typical and atypical mycobacteria, parasites, and fungi can all cause infection leading to inflammatory neck masses. Which is the most common?
Viruses
What is the treatment for neck abscesses?
Surgical incision and drainage and/or intravenous (IV) antibiotics
What types of bacteria are the most common cause of neck masses?
Staphylococcus and streptococcus bacteria
What is the treatment for neckmasses due to bacterial infection?
10-day course of beta-lactamase resistant antibiotic
What pathogen causes cat scratch disease?
Bartonella henselae
What are the common clinical findings in cat scratch disease?
- Large lymphadenopathy (usually unilateral) that enlarges or does not resolve
- low grade fever
- joint or muscle aches
To diagnose Kawasaki syndrome (vasculitis in children 5 years old or less) five of six criteria must be met, one of which is high fever for more than 5 days. What are the other five criteria?
- Cervical adenopathy (at least 1.5 cm in diameter)
- Conjunctival injection
- Rednessof the oral cavity
- Polymorphous exanthem
- Reddening and/or swelling of the palms/soles (sometimes desquamation occurs)
What cardiovascular complication may arise from Kawasaki?
Coronary artery aneurysm
What is the treatment used to prevent the complications of Kawasaki?
- IV immunoglobulin and
- aspirin (one of the few indications for aspirin use in children)
If a patient has a neck mass that by history is suggestive of an infectious process but has not responded to broad-spectrum antibiotic treatment, what tests should you order next?
PPD(test for TB) and chest x-ray
What is scrofula?
Neck lymphadenitis due to mycobacteria (including but not limited to tuberculosis)
How does scrofula typically present?
- As a single large cervical lymph node with an overlying violaceous color appearing later
- strongly reactive PPD when due to tuberculosis
What pathogen causes a disease characterized by acute pharyngitis and cervical lymphadenitis and is thought to have a role in the development of Burkitt lymphoma and nasopharyngeal carcinoma?
Epstein-Barr virus
What are some examples of benign neoplasms that occur in the neck?
- Lipomas
- hemangiomas
- neuromas
- fibromas
Lymphadenopathy in the neck region may signify malignancy. What is significant about lymphadenopathy in the supraclavicular fossa?
The patient may have malignancy somewhere below the neck region (Lungs, GI tract Reproductive system, Kidneys)
When the cause of a neck mass is unclear, in general, what is the best imaging modality for evaluating it?
CT with contrast
