Lateral Neck Lump Flashcards
What are the possible causes of a lateral neck lump?
- Artery
- Nerves
- Lymphatics
- Lymph nodes
- Salivary glands
- Larynx
- Pharynx
- Branchial arch remnant
- Skin/ superficial subcutaneous
- Muscles/ cartilage/ bone
What are the arterial reasons for a lateral neck lump?
- carotid artery aneurysm
- subclavian artery aneurysm
- carotid body tumour
What are the nerve reasons for a lateral neck lump?
- neurofibroma
- shwannoma
What are the lymphatic reasons for a lateral neck lump?
-lymphatic malformations
What are the lymph node reasons for a lateral neck lump?
- infective
- neoplastic (primary or metastic)
- granulomatous
What are the salivary gland reasons for a lateral neck lump?
- infective
- autoimmune
- neoplastic
What are the laryngeal reasons for a lateral neck lump?
laryngocele
What are the pharynx reasons for a lateral neck lump?
pharyngeal pouch
What are the branchial arch remnant reasons for a lateral neck lump?
branchial cyst/sinus/fistula
What are the skin/superficial subcutaneous reasons for a lateral neck lump?
- lipoma
- epidermal cyst
- abscess
- dermoid cyst
What are the muscle/cartilage/bone reasons for a lateral neck lump?
- Sarcomas
- cervical rub
- torticollis
If a child presents with a lateral neck lump what do you think?
- usually benign
- congenital and inflammatory lumps
What are common differentials for children with a lateral neck lump?
- branchial cleft cysts
- lympahtic malformations
- lympahenitis
What are the malignant causes in a child with a lateral neck lumP?
- Lymphoma
- Sarcoma
- Papillary thyroid carcinoma
If a patient is over 40 with a lateral neck lump what do you think?
absence of sings of infection a lateral neck mass in an adult is lypmphadeopathy due to metastatic carcinoma until proven otherwise
If the lateral neck lump has been there for less than a few weeks what would you suspect?
infective or inflammatory lymphadenopathy
If the lateral neck lump has been there for more than a few weeks what would you suspect?
exclude malignancy
If the lateral neck lump has been there for years with little change what would you suspect?
likely benign
Can congenital lateral neck lumps present later on in life?
yes
What would a lateral neck lump gradually increasing in size suggestive of?
malignancy
If the lateral neck lump is painful what would you expect?
acute infective lymphadenitis or infected branchial cyst
If the patient has other lumps not just a lateral neck lump what may this be suggestive of?
systemic disease e.g. HIV, EBV or disseminated malignancy (e.g. lymphoma)
If there are long term infective symptoms with the lateral neck lump what do you think?
malignancy
If there are short term infective symptoms with the lateral neck lump what do you think?
infection
Are the typical FLAWS in head and neck cancer?
not really weight loss or malaise
What are some signs of head and neck cancer?
- Dysphonia
- Stridor
- Stertor
- Breathing difficulty
- Dysphagia
- Odonophagia
- Globus
- Cough
- Haemoptysis
- Otalgia
- Nasal discharge
What may you ask further to decide if it is an infective cause over a malignancy?
- Recent infection?
- History of contact with infectious person?
- Recent trauma, insect/animal bites and scratches?
What may you ask further to decide if it is an malignancy cause over an infection?
- Known or previous cancer?
- FHx of head and neck cancer?
- Previous radiotherapy to neck?
- Smoker and/or high alcohol intake?
What questions should you ask about the specific lump?
- Superficial or deep?
- Anterior or posterior?
- relationship to muscle?
What are examples of superficial lumps for a lateral neck lump?
- lipoma
- abscesses
- epidermal cysts
- dermoid cysts
What are examples of anterior triangle lateral neck lumps?
- Branchial cyst / sinus / fistula
- Carotid body tumour (chemodectoma)
- Carotid artery aneurysm
- Salivary gland
- Laryngocele
- Lymphodenopathy
What are examples of posterior triangle lateral neck lumps?
- Lymphathic malformation
- Cervical rib
- Pharyngeal pouch
- Subclavian aneursym
- lymphadenopathy
How do you determine the relationship to the muscle?
- Ask patient to nod head against resistance will tense sternocloidmastoid muscle on both side of neck
- Shrugging shoulder against resistance will contract trapezius
- Lump underneath the muscle will be concealed when muscle contracts
What other features of a lateral neck lump do you ask about?
- Tender and/or warm?
- Solid or fluctuant
- Pulsatile
- Mobile
What would a tender and/or warm lateral neck lump suggest?
infectious or inflammatory masses exception TB adenitis
What would a hard lateral neck lump suggest?
malignant lymph nodes
What would a rubbery lateral neck lump suggest?
- chronic inflammatory lymph nodes (e.g. TB)
- lymphomatous nodes
What would a soft lateral neck lump suggest?
acute inflammatory lymph nodes
What would a fluctuant lateral neck lump suggest?
- branchial cyst
- cystic hygromas
- pharyngeal pouches
- laryngoceles
- cold abcesses
- epidermal cysts
- dermoid cysts
What would a pulsatile lateral neck lump suggest?
carotid and subclavian are pulsatile (sometimes carotid body tumours)
How are malignant lymph nodes and TB nodes mobile?
- Malignant lymph nodes tethered to adjacent structures
- TB nodes matted together
What else should GP examine if infectious lymphadenopathy suspected?
- Examine throat + tonsils
2. Systematically examine all lymph nodes of head and neck
What else should GP examine if malignant lymphadenopathy suspected?
- Examine scalp, face, ears, mouth, nose for potential squamous cell carcinoma or melanoma
- Otalgia in the absence of any pathology detected by otoscopt suggestive of malignancy (with referred pain to ear)
- Systematically examine all lymph nodes of head and neck
- Examine breasts and lungs
- Consider palpating for hepatospenomegaly if lymphoma or chronic lymphocytic leukaemia is suspected
- Perform full abdominal exam if Virchow’s node palpable
- Use fibreoptic endoscope to examine nasal cavity, nasopharynx, oropharynx, hypopharynx
What else should the GP examine if parotid swelling?
- Examine integrity of facial nerve
2. Examine oral cavity for displacement of soft palate by a tumour involving the deep lobe of the parotid
If lump regarded as squamous cell carcinoma that has metastasied to lymph nodes what urgent investigations do you do?
- US
2. FNA
