H&N2 - Cervical Lymph Nodes & Neck Lumps

Question 1

What are the 2 causes of lymphadenopathy (enlarged lymph nodes)?

What is the appearance of each cause?

Answer 1

Infection - tender and mobile, often associated with a cough and cold
Malignancy - usually hard and non-tender, fast growing, but can be rubbery and mobile (lymphomas)

Question 2

What are 3 differences between superficial lymph nodes and deep lymph nodes

Answer 2

1. ) Superficial are found within superficial fascia whilst deep nodes are found deeper (investing layer)
2. ) Superficial are more readily palpable during lymphadenopathy
3. ) Superficial drain into deep lymph nodes whilst deep lymph nodes will drain directly into the IJV

Question 3

What are the 8 superficial lymph nodes draining the face, scalp, and neck?

Give locations and what drains into them and what they drain into

Answer 3

1. ) Submental (underneath chin) - anything near tongue tip will drain into it
2. ) Submandibular (underneath jaw) - anything back of tongue will drain into it
3. ) Preauricular (before ears) - also covers the eyes
4. ) Postauricular (past ears) - drains things between preauricular and occipital
5. ) Occipital - anything back of the head
6. ) Superficial Cervical (on SCM) - drains into EJV
7. ) Posterior Cervical (behind SCM) - drains into EJV
8. ) Anterior Cervical (front of SCM) - drains into AJV

Question 4

Give 3 features of deep cervical lymph nodes

Location
Important Ones x3
Drainage

Answer 4

1. ) Deep to SCM and closely related to IJV and carotid sheath
2. ) Important Ones: jugulo-digastric, jugulo-omohyoid, supraclavicular
3. ) Some structures within the neck drain directly to the deep cervical lymph nodes e.g. thyroid and posterior tongue and tonsils

Question 5

What is Waldeyer’s Ring

What are the 4 tonsils (lymph nodes) in Waldeyer’s Ring?
From tip to back of mouth

Answer 5

Collection of lymphoid tissue surrounding the upper aerodigestive tract (pharynx)

Lingual
Palatine
Tubal
Pharyngeal (adenoids)

Question 6

What 4 things do you look for when examining neck lumps?

Answer 6

1. ) Normal History
2. ) Location - which triangle? midline or laterally placed?
3. ) Movement - with swallowing or sticking out tongue
   - sugggests thyroid gland affected because the pretracheal fascia is attached to the hyoid bone
4. ) Palpation features - superficial? fixed? tender? redness?

Question 7

What are the 6 possible causes of a neck lump?

Answer 7

Superficial - cysts (dermoid), skin abcess, lipoma (fat)
Inflammatory - e.g. tonsillitis, mouth ulcers
Congenital Lesions - thyroglossal cysts, branchial cysts
Gland Pathology - thyroid (goitre), salivary gland
Cancer - primary or metastatic disease involving a lymph node
Other - chronic infections, carotid artery aneurysm

Question 8

What could cause neck lumps in the anterior triangle?

Midline (3) and Lateral (1)

Answer 8

Midline - dermoid cysts, thyroglossal cysts, goitre

Lateral - branchial cyst

Question 9

5 red flags for lymphadenopathy

Answer 9

Persistence - >6 weeks
Appearance - fixed, hard, irregular
Size - rapidly growing
Systemic Symptoms - weight loss, night sweats
Unexplained change in voice or difficulty swallowing (laryngeal cancer)