Lymphadenopathy and Ax neck region Flashcards
What is a thyroglossal cyst?
- arises from thyroglossal duct
- sits over thyroid
- most common congenital neck mass
- elevates on swallowing/protrusion of tongue
Red flags for neck lumps (8)
1 older, especially > 70
2 bigger nodes, >3cm
3 single node and enlarging
4 fixed to skin without punctum (not a sebaceous cyst)
5 associated dysphagia
6 hard midline thyroid lump
7 patient at risk of malignancy or HIV or with constitutional symptoms
8 exposure to TB or HIB
What do following lymph nodes drain?
1 pre auricular
2 post auricular
3 submental
4 submandibular
5 anterior cervical
6 posterior cervical
7 supraclavicular
1 scalp, skin
2 upper part of external ear, posterior neck, posterior part of temporoparietal region, posterior ear canal
3 lower lip, chin, tongue and teeth
4 oral cavity (submental)
5 larynx, tongue, oropharynx, anterior neck
6 scalp, neck, upper thoracic skin
7 GIT, GUT, pulmonary
Characteristics of lymphadenopathy (2) localised vs generalised ?
1 enlargement
2 alteration in texture
- localised (think of regional drainage and local pathology)
- generalised (thing of systemic causes)
Red flags for upper limb
1 epitrochlear lymph nodes are nearly always malignant
2 Infraclavicular - non Hodgkin Lymphoma
Staging of lymphoma 1-4
1 localised to one node or group of nodes
2 more than one nodal site on the same side of the diaphragm
3 involvement of nodes above and below diaphragm
4 involvement of extranodal sites - liver, bone marrow
Each stage may be with or without constitutional symptoms
Lower limb lymph drainage (2)?
Horizontal and Vertical
- these groups drain lower abdomen, external genitalia (skin), anal canal, lower 1/3 vagina, lower extremity
4 lymph node rules
1 hard, tethered = metastatic
2 rubbery, mobile = lymphoma
3 soft, tender = infection
4 generalised = infection, low grade lymphoma (CLL)
Upper limb lymph drainage (3)?
Epitrochlear - ulnar forearm and hand
Infraclavicular - highly suspicious for Non Hodgkins Lymphoma
Axillary - drain breast, upper extremity and thoracic wall
What 2 viruses are associated with what HANC?
EBV - nasopharyngeal SCC
HPV - tonsillar and tongue base SCC
Oropharyngeal cancer cause
HPV - rising
Paediatric approach to lymphadenopathy
malignancy is rare
- Ix rarely required
- resolve with time
- US/FNA if unchanged/enlarging
Goitre - permberton’s sign?
Sign of partial venous obstruction
- Arms up above head
- Congestion of face - red face
Name 1 superficial and 3 midline neck lymps that are NOT lymph nodes
1 common skin lesions e.g. sebaceous cyst
1 thyroid nodule
2 thyroglossal cyst
3 dermoid cyst
