L6: Cervical lymph nodes and neck lumps Flashcards
What does it mean when you say neck lumps have a very wide differential?
It means there is a wide collection of causes it could be
- cervical lymphadenopathy is common cause due to recent infection/inflammation
- but can also be secondary to an underlying cancer
How do you approach neck lumps?
History
- AGE (children: enlarged lymphnode>likely secondary to infection)
- duration, progression, associated signs/symptoms
Examination
- relate location to underlying structures
- midline/laterally
- movement with swallowing: thyroid /sticking out the tongue:thyroglossal duct cyst
- palpation features
What are some features of palpation?
- does it feel superifical?
- mobility
- hard/soft/smooth/irregular
- fixed to surrounding tissue
- tender
- overlying skin changes
What are some causes of neck lump?
- superficial: sebaceous cyst/dermoid cyst/lipoma/skin abcess
- inflammatory/infective: tonsilitis/mouth ulcer
- congenital lesions: thyroglossal duct cysts/branchial cysts
- thyroid pathology
- salivary gland pathology
- other: chronic infection (TB/HIV)
Why does a dermoid cyst arise?
Congenital defect
What are some lumps that appear along the midling generally?
- dermoid cyst (does not move on swallowing/tongue protrusion, pea size, not painful to palpate)
- thryoglossal duct cyst (embryological development, and moves on swallowing and tongue protrusion)
- thyroid gland pathology(lump moves with swallowing)
How does a thyroglossal duct cyst form?
The duct which connects the thyroid gland to the tongue persists, when normally it should obliterate and close off. Whenit persists, cysts and collection of fluid can arise.
What are some lumps that appear laterally in the neck?
- submandibular pathology (cancer/blockage)
- brachial cyst (congenital, found along anterior border of SCM, don’t always present at birth)
What could ANY lump in the neck be?
Lymphadenopathy
What would you find if you had a brachial cyst?
- palpation findings as it is a fluid filled cyst
- tranluminate if light source is shone
- can become infected and therefore painful
- can form sinuses with the skin to discharge their contents
- come apparent after an upper respiratory tract infection/virus
Is lymphadenopathy a diagnosis?
No, it is a sign of an underlying disease
What are the red flags for lymphadenopathy?
- persisting > 6 weeks
- fixed, hard, irregular
- rapidly growing in size
- associated with generalised lymphadenopathy (e.g. lymphomas/HIV)
- associated systemic signs/symptoms (e.g. weight loss/night sweats)
- associated with persistent (unexplained) change in voice/hoarsness or difficulty swallowing
What is a lipoma?
Lump under skin that occurs due to overgrowth of fat cells. (Benign tumour)
