Neck Lump

Question 1

Thyroglossal duct cyst presentation

Answer 1

• Most common midline neck cyst
• Children/adolescents
• 75% at hyoid
• Can present with infection

Question 2

Thyroglossal duct cyst investigations

Answer 2

• USS- confirm thyroid present and cystic nature of lesion

* TFT

Question 3

Thyroglossal duct cyst treatment

Answer 3

• Abx for acute infections
• Consider I&D
• Sistrunk procedure

Question 4

Dermoid cyst presentation and origin

Answer 4

• Form along lines of embryological fusion
• Can be lined by
– squamous epithelium,
– squamous epithelium and skin appendages
– all elements of ectoderm
• Painless swellings, do not move
on tongue protrusion
• Simple excision/Sistrunk’s if nature in doubt

Question 5

Branchial Cleft Cyst/Sinus 2nd arch: presentation + investigation

Answer 5

• M:F 3:2
• Ant to SCM
– External opening anterior to SCM below hyoid
• Can get infected
• Investigations
– USS/sinogram/CT/MRI

Question 6

Branchial Cleft Sinus 1st arch type 1 and 2

Answer 6

• Type 1 Runs medial, posterior or inferior to the conchal cartilage
• Type 2 run into the neck sup to hyoid
• Pit at angle of mandible, often arise in EAC
• Closeandvariablerelationship to VII

Question 7

Pre Auricular Pits presentation and treatment

Answer 7

• Abnormality of 6 hillocks of His
• Only treat if symptomatic
• Rec infections
• Abx/I&D/Excision

Question 8

Cervical Lymphadenopathy in children. Being vs malignant features

Answer 8

• 50% 6m-6 years will have palpable lymphadenopathy
• Majority are reactive
• Malignancy is rare
• Onset in neonatal period • Progressive increase
• Wt loss
• Sweats
• Hx previous malignancy
Hx: URTI, fluctuation size with infection, scalp conditions, cat scratch, travel,TB exposure suggest benign cause

Question 9

Examination of lumps -benign factors

Answer 9

• Soft
• Mobile
• Tender
• Local infective cause found
• Skin dis-colouration

Question 10

Examination of lumps - Sinister features

Answer 10

• Wt loss
• Firm rubbery consistency
• > 1cm in <1yr
• > 3cm in >1 year
• Irregular
• Solitary and supraclavicular

Question 11

Causes of Infective Lymphadenopathy

Answer 11

Viral
• CMV/EBV
• Similar presentation • Serology is best test
• Monospot variable in adults, more so in children

Acute Bacterial
• Staph and group B strep • Recent URTI common
• Abx with B lactam
• Fluctuance/spiking fever 
• Abscess will need I&D

Question 12

Atypical TB features

Answer 12

Mycobacterium avium
• Found in soil
• 2-5 year olds
• Submandibular mass for weeks • Red-purple skin
• CXR usually clear • PPD test negative
• Excision
• Long term clarithromycin/azithromycin (3-6 months)

Question 13

Zoonotic Causes of Lymphadenopathy

Answer 13

• Bartonella henselae
• Rickettsial organism
• Primary inoculation of skin, eye, mucosal membrane leaves a small
papule.
• Fever malaise, fatigue may follow the primary inoculation which has gone unnoticed.
• Diagnosis with serology and supportive treatment vs. Azithromycin for 1/52

Question 14

Parasitic Causes of Lymphadenopathy

Answer 14

• Toxoplasmosis gondii
• Single celled parasite
• Soil containing cat faeces, contaminated water, raw meats
• Flu like Sx with lymphadenopathy
• Mostly passes with supportive treatment
• Beware immuno-compromised or infection in neonatal period.

Question 15

Kawasaki’s disease- inflammatory causes of Lymphadenopathy

Answer 15

• Vasculitis
• Fever,
• conjunctivitis,
• oropharyngeal inflammation
• Rash, palmar/feet erythema
• Generally 75 % significant LN, solitary

Question 16

Paediatric Neoplasia- Benign

Answer 16

• SCM Tumour of Infancy
• Firm mass
• +/-torticollis
• Bleeding into muscle-fibrosis • USS/CT
• Physio
• SCM release if Sx >8-9 months
• Lipoma
• Papilloma • Neuromas