Neck

Question 1

Enlarged Thyroid is called

Answer 1

Goiter

Can be caused by hyper/hypo thyoidism

Need to go for testing and monitoring

Question 2

Normal Exam Findings - Neck (2)

Answer 2

• Normal texture is soft and without nodular
• Size of the lateral lobes of the thyroid may be compared to the size of the third phalanx of a child’s thumb

Question 3

Pathophysiology of the Thyroid Gland

Answer 3

• Goiter
  
  • Enlargement of the thyroid – can be euthyoid, hypothyroid, or hyperthyroid
• Thyroid nodules
  
  • Nodules in children need referral to endocrine to see if they want to biopsy

Question 4

Congenital Neck Mass

Answer 4

• Cystic hygroma (lymphangioma)
• Hemangioma
  
  • Interfere with airway – Beta Blockers
• Branchial Cleft Cyst
  
  • Most common
  • 20-30%
  • Present in late childhood and early adulthood when acutely infected
• Thyroglossal duct cyst
  
  • Midline lesion

Question 5

Cystic Hygroma

Prevalence

Answer 5

• 1 in 1200 births
• Multiloculated cystic lymphatic malformation
• By second year, usually found
• 2:1 left side
• Discrete, soft, mobile, non-tender, cystic masses in posterior triange of neck
  
  • Feels soft and full of fluid

Question 6

Cystic Hygroma

Patho

Answer 6

• Collection of lymphatic sacs that contain clear, colorless lymph
• Congenital and probably represents a cluster of lymph channels that failed to connect into the normal lymphatic pathway
• As it grows, may cause tracheal compression and stridor

Question 7

Cystic Hygroma

EARLY VS. LATE DETECTION

Answer 7

• Located more frequently on left side
• Dx in the period immediately after birth, with large lesions being noted on prenatal ultrasonography
• Later presentations generally follow a viral infection, which can induce significant expansion of these lesions
• Large lesions can result in airway compromise
• PRENATAL ULTRASOUND CAN PICK UP!!!

Question 8

Second Bilateral Cleft Cyst

Answer 8

• Most common congenital neck mass
• 2-3% population
• Branchial cysts
• Smooth, nontender, fluctuant masses, which occur along the lower one third of the anteromedial border of SCM betwen the muscle and the overlying skin

Question 9

Branchial Cleft Cyst Presentation

Answer 9

• Presents as a solitary, painless mass in the neck of a child or a young adult
• May retract with swallowing, tends to get infected
• Typical presentation is small cartilaginous horn in lower anterior border of sternocleidomastoid
• PENCIL POINT

Question 10

Thyroglossal Duct Cyst

Location

Answer 10

• Usually found be low the level of hyoid bone in mid line or off center
• Seen best when neck is hyperextended
• Cyst may rise with tongue protrusion and swallowing since it is connected to base of tongue

Question 11

Thyroglossal Duct Cyst

High incidence of

Anywhere from…..

Answer 11

• Only thyroid tissue patient has can occur anywhere from the base of tongue to diaphragm
• High incidence of thyroid carcinoma in adulthood