Lecture 2 - Cervical Lymph Nodes + Neck Lumps

Question 1

What are the 3 main roles of the lymphatic system?

What are the 2 clinical manifestations involving the lymphatic system?

Answer 1

1) Remove excess fluid from interstitial space
2) Return small proteins and fluid leaked from capillaries
3) Role in immune defence and surveillance

1) Lymphoedema - accumulation of lymphatic fluid causing tissue swelling
2) Lymphadenopathy - swollen lymph nodes due to infection of malignancy

Question 2

What 3 lymph nodes are palpable especially during infection?

Answer 2

1) Cervical (neck)
2) Axillary (armpit)
3) Femoral (groin)

Question 3

What are the 2 main causes of lymphadenopathy and how would these feel when palpating them?

Answer 3

1) Infection (most common) - tender and mobile lymph nodes

2) Malignancy - either hard, matted & non-tender or rubbery, mobile and fast-growing.

Question 4

What 2 groups are lymph nodes organised into and where are they found?

Answer 4

1) Superficial - within superficial fascia

2) Deep - many associated with route of IJV in carotid sheath in neck.

Question 5

What do superficial lymph nodes in the neck drain into|?

Answer 5

The deep lymph nodes associated with the internal jugular vein, within the carotid sheath.

Question 6

Which tonsils form Waldeyer’s ring of lymphoid tissue?
What is their locations?
What is their role?

Answer 6

• Palatine, pharyngeal, lingual and tubal tonsils
• They form a ring at the back of the throat
• Prevent infections from penetrating deeper into the body (first line defence)

Question 7

What is a common cause of neck lump?

What can this be due to?

Answer 7

• Cervical lymphadenopathy

- Recent infection/inflammation or secondary to underlying cancer

Question 8

What are some alternative causes of neck lumps?

Answer 8

Superficial - e.g.: sebaceous or dematoid cyst
Inflammatory lymph nodes - e.g.: tonsilitis, mouth ulcer
Congenital lesions - e.g.: thyroglossal cysts
Thyroid pathology - benign or malignant
Metastatic disease - primary or secondary involving lymph node
Salivary gland pathology

Question 9

Name 3 causes of midline neck lumps

Name 3 causes of lateral neck lumps

Answer 9

1) Thyroid gland inflammation 2) Thyroglossal cysts 3) Dermoid cysts
1) Branchial cysts 2) Submandibular gland enlargements 3) Cancer

Question 10

What are the neck flags for neck lumps that indicate concerning underlying pathology? (e.g.: head + neck cancer)

Answer 10

• Persistent (6 + weeks)
• Fixed, hard + irregular
• Rapidly growing in size
• Associated with generalised lymphadenopathy
• Associated systemic signs, e.g.: weight loss
• Associated with persistent change in voice or difficulty swallowing