Management of thyroid nodules (neck swellings) Flashcards
What are the boundaries of the anterior triangle in the neck ?
- Superiorly - mandible
- Laterally - anterior aspect of SCM
- Medially - imaginary line down the midline
What are the boundaries of the posterior triangle of the neck ?
- Inferiorly - clavicle
- Laterally - trapezuis
- Medially - posterior aspect of SCM
What are the superficial causes of neck lumps ?
- Sebaceous cysts
- Lipomas
- Neurofibromas
What are the main midline causes of neck lumps ?
- Thyroid
- Thyroglossal cyst (remember thyroglossal duct in thyroid development)
- Dermoid cyst (sack like growth on or in the skin present at birth)
- Pharyngeal pouch (this is rare)
What are the causes of neck lumps in the anterior triangle ?
- Lymph nodes
- Branchial cysts
- Salivary glands
- Carotid body tumour
What are the causes of neck lumps in the posterior triangle?
- Lymph nodes
- Cystic hygroma
What are the most common casuses of neck lumps ?
- Lymph nodes - 85%
- Goitre - 8%
- Other 7%
If a patient has cervical lymphadenopathy what do you also need to check ?
- Look for other nodes
- Hepatosplenomegaly
What are the potential causes of cervical lymphadenopathy ?
- Infective
- Malignant
- Haemotoligcal - leukaemia/ lymphoma
If the patient has hoarseness and neck lump what are you worried about ?
Cancer - potentially causing damage to the recurrent laryngeal nerve resulting in hoarness
What can you do to find out the cause of a neck lump?
- Exammine it
- USS FNA
What complication can develop in thyroglossal cysts and branchial cysts ?
The can fistulate and saliva can then come out the hole
How do thyroglossal cysts commonly present ?
- As a midline swelling
- They contain lymphatics which can become inflamed
- They move when the tongue is stuck out
- Usually present in teenage years
How do dermoid cysts commonly present ?
- Usually in teenage years
- As a midline swelling
- Sac like growth on or in the skin
- Described as a ‘‘half filled water bottle’’
What are the clinical features suggestive of a pharyngeal pouch causing neck swelling ?
- More common in older men
- Midline lump in the neck that gurgles on palpation
- Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
Note only large ones will cause neck swelling
What is a branchial cyst due to ?
Persisting second branchial arch
What are the clinical features of a branchial cyst
- Slowly enlarging
- Smooth, soft, fluctuant
- Non-tender
- May develop a fistula ==> saliva may come out
On FNA aspiration of a branchial cyst what would be seen?
Cholestrol crystals
When/where do cystic hygromas/lymphangiomas commonly present ?
- In posterior triangle
- Majority in first year of life
- They are lymph filled and transilluminable
What investigations would you do for a thyroid gland swelling ?
TSH and USS FNA
When you stick your tongue out the swelling moves - what is the cause of this neck swelling ?
Thyroglossal cyst
What in the history may suggestive reactive (infection causing) lymphadenopathy ?
There may be a history of local infection or a generalised viral illness
What features would potentially suggest lymphoma as the cause of neck swelling ?
- Rubbery, painless lymphadenopathy
- Night sweats
- Splenomegaly
- +/- the phenomenon of pain when drinking alcohol (see haem notes for specific lymphoma type)
If a midline swelling moves when you swallow what do you think is the cause ?
What other features may be present with this type of swelling ?
- Thyroid - it moves because pretacheal fascia envelops it
- Additional features - May be hypo-, eu- or hyperthyroid symptomatically
