Neck - Clinical Flashcards
What is your differential for neck lumps in the midline?
- Dermoid cyst
- Thyroglossal cyst
- Goitre/Thyroid mass
- Chondroma
What would your differential diagnosis be for a lump in the submandibular triangle?
- Ractive lymphadenopathy
- Malignant lymphadenopaty
- Salivary duct infection
- Sialitis
- Salivary sjogren’s/Sarcoidosis
- Submental dermoid
What would you differential diangosis be for a midline lump that moved on protrusion of the tongue?
Thyroglossal cyst
What would you think as a diagnosis for a midline neck lump which moves on swallowing?
Thyroid goitre (thyrotoxicosis/Hypothyroid/Euthyroid)
What would your differential diangosis be for a thyroid goitre?
- Graves disease
- Hashimoto’s thyroiditis
- Simple goitre
- Toxic multinodular goitre
- Non-toxic multinodular goitre
What would your differential diagnosis be for a solitary thyroid nodule?
- Autonomous toxic thyroid nodule
- Thyroidcarcinoma
- Thyroid adenoma
- Thyroid cyst
What would your differential diagnosis be for a lump in the anterior triangle of the neck?
- Lymph node inflammation
- Acute abscess
- Tuberculosis abscess
- Branchial cyst
- Cystic hygroma
- Pharyngeal pouch
- Carotid body tumour
- Carotid artery aneurysm
- Lymphoma
What would you differential diangosis be for a neck lump in the posterior traingle of the neck?
- Acute abscess
- Cystic hygroma
- Lymphadenopathy
- Lymphoma
- Metastasis
- Tuberculous abscess
What would your differential diagnosis for supraclavicular neck lumps be?
- Lymphadenopathy
- Lymphoma
- Metastatic from gut or lung
- Subclavian artery aneurysm
How would you assessing a neck lump?
- How long has it been present for?
- Site, size, shape, number?
- Smooth/Lobulated?
- Solid or cystic?
- Tender/Non-tender?
- Thethering?
- Pulsatile?
- Moves on swallowing/sticking out tongue?
- Associated ulceration/Inflammation in head and neck?
What tests would you perform if you found a lump in the neck?
- US of lump
- FNA cytology
- CT
- Consider CXR
What would you check for in the abdomen if you found a lump in the neck?
- Hepatosplenomegaly - signs of lymphoma/reticuloendothelial system inflammation
- Masses - if around virkow’s node
How would you palpate lymph nodes in the neck?
Trace a Z - Zones 1-6
What blood tests might you consider doing if you found a lump in the neck?
- FBC
- Monospot
- HIV
What is the embryological remnant implicated in the development of a thyroglossal cyst?
Foramen caecum - normally resorbs, but if remains, cysts can form
How would you manage a thyroglossal cyst?
Surgical excision of whole tract
What is the following likely to be?
Branchial cyst - may be other differentials though
Where to branchial cysts most commonly present?
Middle third of the sternocleidomastoid
What is thought to be the cause of a branchial cyst?
Previously thought to arise from an abnormality of fusion of the embryological branchial clefts, but more recently suggested that they may result from epithelial inclusions within a lymph node that later undergoes a process of cystic degeneration
What might you find on aspiration of a branchial cyst?
Pus like aspirate rich in cholesterol, lined with squamous epithelium
How would you manage someone with a branchial cyst?
Surgical excision
What is a cystic hygroma?
Rare type of lymphangioma (benign tumour of the lymph vessels)
What might the following be?
Cystic hygroma
What is a dermoid?
Painless midline swelling anywhere between suprasternal notch and the chin. Result from defects of fusion in the embryo, but elements of the skin become trapped subcutaneously and develop into cysts lined with squamous epithelium
