Lumps in the neck Flashcards
Description of a neck lump 4s, 4t, 3f, 2l
Site (deep to skin, fascia, muscle), size, shape, shift Temperature, tender, transilumination, thrill Colour, contour, consistency, cough impulse Fluctuating, filling/emptying, flow-bruit Lymph drainage, lumps elsewhere
Categories of neck lump surgical seive
Congenital Infectious/inflammatory Granulomatous Neoplastic
Acquired causes based on age: <20, 20-40, 40
<20: 1. Congenital, 2. Inflammatory, 3. Neoplastic
20-40: 1. Inflammatory, 2. Congenital, 3. Neoplastic
40: 1. Neoplastic, 2. Inflammatory, 3. Congenital
Congenital neck lumps- lateral and midline
Lateral: branchial cleft cyst, lymphatic/venous malformation Midline: thyroglossal cyst, dermoid cyst, laryngocele
Infectious/inflammatory differential (8)
Reactive lymphadenitis HIV EBV Kawasaki Kimura Kikuchi Salivary gland calculi, sialedenitis Thyroiditis
3 K’s of inflammatory neck lumps
Kawasaki, Kimura, Kikuchi
Granulomatous differential (2)
Sarcoidosis Mycobacterium
Neoplastic differential
Salivary gland tumor Lymphoma Metastatic Thyroid gland tumor
When is a cervical and inguinal LN considered enlarged
>1cm cervical >1.5 cm inguinal
Define generalised adenopathy
>2 non contiguous LN- usually systemic illness
Indications for LN biopsy
>2cm Systemically unwell Generalised Splenomegaly
Causes of cervical lymphadenopathy
Oropharyngeal infection, scalp Mycobacterial lymphadenitis Cat scratch Toxoplasmosis Kawasaki Thyroid
Auricular lymphadenopathy causes
Conjunctivitis Eye infection Facial cellulitis
Psoterior auricular lymphadenopathy
Otitis media Rubella, parvovirus
Supraclavicular lymphadenopathy
Mediastinal malignancy Abdominal malignancy (left) Lymphoma TB
Epitroclear lymphadenopathy
Hand/arm infection Lymphoma Sarcoid Syphilis
Inguinal lymphadenopathy
UTI Venereal disease Perineal infection Lower extremity suppurative infection
Hilar lymphadenopathy
TB, Histoplasmosis, Blastomycosis, Coccidioidomycosis Sarcoid Hodgkin lymphoma Metastatic
Axillary lymphadenopathy
Breast cancer Leukemia/lymphoma Cat scratch Brucelliosis
Generalised lymphadenopathy- infant, child, adolescent
Infant: Syphilis, Toxoplasmosis, CMV, HIV Child: EMV, CMV, HIV, Toxoplasmosis Adolescent: EBV, HIV, CMV, Toxoplasmosis, Syphillis
Some rare causes of generalised lymphadenopathy
Leukemia, SLE, RA, Sarcoidosis, Drug reaction
Categorising generalised lymphadenopathy (6)
Leukemia Lymphoma Infections Connective tissue disorders Infiltration Drugs
Evaluation of a neck mass- investigations
History and physical examination (head, neck, chest, lungs, abdomen, other lymph nodes) Laboratory- FBC, Mantoux TB (PPD), TFTs/scan Imaging- Neck U/S, CT, angiography, imaging of stomach, bowel, sinuses as indicated by history Biopsy- FNA Identify primary tumor
What is MAIS
Atypical Mycobacterial (non-TB) Lymphadenitis
Signs and symptoms of MAIS
Fixed lateral neck mass, erythema, stud abscess with discharging sinus in neck
Which test is highly positive in MAIS
Mantoux test
Management of MAIS
Surgical excision
Embryology of branchial cleft cyst
At 6th week developemtn, 2nd branchial arch grows over 3rd and 4th fusing with neighbouring caudal pre-cardial swelling= cervical sinus
Types of branchial abnormalities
Fistula, sinus and cyst
Clinical features of 2nd branchial cleft malformation
Fistulas in infancy small opening anterior to SCM Cysts smooth, enlarging, painless, lateral neck mass following URTI
Clinical features of 1st branchial groove malformations
Pre-auricular pit/sinus
Treatment of branchial cleft cyst
Excision
Embryology of thyroglossal duct cysts
Thyroid develops from base of tongue as ventral midline diverticulum, caudal to junction of 3rd and 4th branchial arches. It is a vestigial remnant of the tract
Clinical features of thyroglossal cyst (presentation, enlarges, movement)
Presents in early childhood as midline swelling, enlarges with URTI and moves up with protrusion of the tongue
Management of thyroglossal cyst
Antibiotics to reduce inflammation Complete excision (removal of central hyoid)
Why does a thyroglossal cyst need to be removes
Has small neoplastic potential
Evaluation of a neck mass
- HPC
Duration
Painful
Sore throat, URTI, toothache
- Review of systemc
Swallowing, speaking
Weight loss, fatigue, malaise
Regional/distant cancers->cough. dysphagia
Complete R/V
- PMHx
HIV
TB
Risk factors
Alcohol
Tobacco
Chronic candidiasis
Poor dental hygeine
- Examination
Neck lump
Regional
Breast and prostate
Spleen
Stool
Other LNs palpated
