Neck Lump

Question 1

Differential diagnosis lateral neck lump

Answer 1

Artery; carotid artery aneurysm, subclavian artery aneurysm, chemodectoma
Nerves; neurofibroma, schwannoma. Both benign tumors of myelin sheath, neuro will encase the nerve sheath, schwannoma will displace nerve root
Lymphatic; lymphangioma (simple , cavernous, cystic hygroma)
Lymph nodes; infective, neoplastic, granulomatous
Salivary glands; infective, autoimmune, neoplastic
Larynx; laryngocele
Pharynx; pharyngeal pouch
Brachial arch remnant; brachial cyst, sinus, fistula
Skin/ superficial fasia; lipoma, epidermal cyst, abscess, dermoid cyst

Question 2

Age effect ddx in lateral lump

Answer 2

Children-75% benign- usually congenital/ inflammatory lumps
Usually thyroglossal cysts p, brachial cleft cysts, cystic hygromas, lymphadenitis
If malignant usually lymphoma or sarcoma sometimes papillary thyroid carcinoma

Adults 75% malignant- usually 80% mets, rest lymphoma

Question 3

Questions about the lump

Answer 3

How long it’s been there- if less than few weeks likely infection/ inflammation.
Brachial cysts often appear after an episode of infection
Has it got bigger smaller- lump increasing malignant until proven otherwise
Painful? Acute infective lymphadenitis, infected brachial cyst.
Other lumps?

Question 4

Associated symptoms

Answer 4

Fever
Night sweats
Rigors
Malaise 
Appetite
Weight loss 

Head and neck cancer usually no weight loss etc, do have dysphonia, stridor, breathing difficulties, dysphasia, unilateral hearing loss, cough, globus, nasal discharge