Neck Anatomy and Lumps

Question 1

What are the boundaries of the anterior triangle?

Answer 1

Superiorly - mandible
Medially - midline
Laterally - anterior border of SCM

Question 2

What are the boundaries of the posterior triangle?

Answer 2

Anteriorly - posterior border of SCM
Laterally - anterior border of trapezius
Inferiorly - mid-third of clavicle

Question 3

What can arise as superficial swellings in the neck?

Answer 3

Sebaceous cyst
Lipoma
Neurofibroma

Question 4

What 2 questions should you ask when considering a midline swelling?

Answer 4

Does it move on swallowing?

Does it move on sticking out the tongue?

Question 5

Give causes of a midline swelling in the neck.

Answer 5

Dermoid cyst
Thyroid - solitary nodule or MNG
Thyroglossal cyst

Question 6

What is a dermoid cyst?

Answer 6

rare congenital cyst

soft, non-fluctuant

Question 7

What is a thyroiglossal cyst?

Answer 7

Can arise in any part of the Thyroglossal tract
Lymphatics may become infected
Usually presents in teenage years
Can be taken out but leaves scar

Question 8

Does a thryoglossal cyst tend to move on swallowing?

Answer 8

No - tends to move when the tongue is stuck out

Question 9

List 4 causes of anterior triangle swellings.

Answer 9

Lymph nodes
Branchial cyst
Salivary glands
Carotid body cyst

Question 10

Decribe the features of a branchial cyst.

Answer 10

Persisting second branchial arch
arise in upper part of anterior triangle
Usually presents in teenage years
May fistulate

Question 11

If FNA is performed on a branchial cyst, what would you expect to find?

Answer 11

Cholesterol crystals

Question 12

What can cause a swelling within the posterior traingle of the neck?

Answer 12

Lymph nodes

cystic hygroma

Question 13

Cystic hygroma?

Answer 13

Majority present in 1st year of life 
Can be large 
Pressure symptoms 
lymph filled and transilluminate 
very difficult to excise

Question 14

Can cystic hygromas recur once they are excised?

Answer 14

Yes

Question 15

When consulting with a patient with regards to their neck lump, what questions should you always ask?

Answer 15

Onset 
growth or change 
previous lumps 
tender or sore 
previous neck irridation

Question 16

On inspection and eamination of the lump, what does SCT stand for?

Answer 16

site, size, shape, surface
colour, consistency, compressible
Tender, transilluminable, tethered

Question 17

Besides SCT what else do you need to consider on inspection/examination of a neck lump?

Answer 17

Abnormal movement
skin changes - scars, pigmentation, rashes, spider naevi
Other symptoms?
recent immigration/ travel abroad

Question 18

What other symptoms to you want to ask a patient with a neck swelling?

Answer 18

Systemic symptoms: fever, weight loss, sweats (infection?)

Specific symptoms: hoarseness, cough, dyspnoea (recurrent laryngeal nerve palsy?)

Question 19

What Ix can be used to decide the cause of a neck swelling?

Answer 19

TSH/ T4/ T3
USS guided FNA
Thyriod isotope scan (if TSH suppressed)