Neck lump differentials Flashcards
what should you look for in a history when being presented with a neck lump
- history
- age ( in cbildren enlarged lympnode is likely secondary to infection
- duration, progression, associated symptoms and signs e.g. red flags
what should look for when examining a neck lump
- relate locatio to knowledge of underlying structures
- anteriro or psoteiror triagnle? Mdiline or laterally placed?
- movement with swallowing and sticking out tongue
- palpation
features to look for when palpating neck tumour
- does it feel superifical or deep
- mobile or immobile
- hard/soft/smooth/irregular
- tender (inflamed/infected lumps are painful)
- overlying skin changes e.g. red
what are some of the possible causes of neck lumps
- superficial e.g. sebacaeous cyst, dermoid cyst, lipoma, skin abscess
- inflammaotry/infective lymph node e.g. tonsilitis, mouth ulcer
- congenital lesions e.g. thryoglossal and branchial cysts, laryngocele
- thryoid pathology - malignant or bening
- primary (e.g. lymphoma) or secondary malignant (metastatic) disease involving the lymph node
- salivary gland pathology (calculus, infection, tumour)
- other e.g. chronic infection (TB, HIV) can cause lympahdenopathy, also carotid artery aneurysm
name some superifical causes of enck lumps
sebacious cysts, dermoid cyst, lipoma
name some causes of inflammatory/infective lymph nodes
tonsilitis, mouth ulcers
name some congenital causes of nekc lumps
thyroglossal cysts, branchial cysts, laryngocoele
thyroid pathology can be
malignant or benign
primary cancer of the lymph node
lymphoma
secondary malignancy of the neck lymph node
metastatic
supraclavicular node drain the
thorax and abdomen- Virchows node (think of johnny)
salivary gland patholgoy
calculus, infection, tumour
other causes of neck lumps
chronic infection (TB, HIV)
carotid artery aneurysm
Lymphadenopathy is very common case for neck lumps. They can be caused due to:
- Infection (most common)
- Tender and mobile
- Malignancy
- Hard, matted, non-tender
- Or rubbery, moviel and fast growing
relationship between superifical and deep lymph nodes
superfical lymph nodes (more readily palpable) drain into the deep lymph nodes within the carotid sheath
deep lymph nodes most associated with
internal jgual vein along its length within the carotid sheath
Key areas for lymph nodes on the face, scalp and neck
what tests could you do on a pt that presents with a neck lump
- FBC
- virology serology
- chest x-ray
- throat swab
- FNAB (fine needle aspiration biopsy)
- ultrasound
what are some possible differentials for a neck lump apart from lymphoma
lipoma, thymoma
what area do the supraclavicular nodes drain
-overswe transport of lymph frpm the thoracic cavidy and abdomen
left node= abdomen and thorax (virchows node)
right node= mid section chest, oesophagus and lungs
what initital imaging choice for a neck lump and why
US
- can see superficial
- no radiation
- can biopsy
red flags for lymphadenopathy
- persisting >6 weeks
- fixed hard and irregular
- rapidly growing in size
- associated with generalised lymphadenopathy- check other node groups
- systemic signs/sympotms e.g. weight loss or night sweats (TB or lymphoma)
- associated with a peristent change in voice/ hoarseness or difficulty swallowing (pharynx or larynx cancer)
differentials of a lateral neck lump
Submandibular triangle
- reactive lymphadneopathy (children)
- submandibular gland disease e.g. stone
Anterior triangle
- reactive lymphadenopathy (children)
- neoplastic lymphadenopathy (firm, non-tender, older)
- Branchial cyst
- lateral thryoid masses
- parotid gland disease
- laryngeocoel
Posterior triangle
- reactive lymphadenopathy (younger)
- neoplastic lymphadenopathy (firm, non-tender, older)
- lipoma
- cervical rib
Branchial cyst
branchial cyst
- lateral to midline in the anterior triangle
- in front of SCM (superficial)
- congenital- remnant of second branchial cleft
- does not move on swallowing
midlien lymp differentials
- thryoglossal duct cyst
- dermoid cyst
- thyroid pathology
- general lympadenopathy
thyroglossal duct cysts
- near hyoid
- pea sized cyst
- when the connection between the tongue and thyroid is never lost
- stick tongue out will move
dermoid cyst
congenital
will not move on swallowing
thyroid pathology
- cancer
- goitre ( TSH, T3/T4)
- will move on swallowing
how can you tell the difference between this beign a lipoma and goitre
- cant get fingers around goitre
- moves up when swallowif if a goitre
typical history of extradural haemorrhage
defined head injury
any age, lose consciousness intitially but then wake up and fine, lucid intevral, deterioration
usually an arterial bleed e.g. middle meningeal artery- sits below the thinnest part of the skull
typical history of subdural haemorrhage
Venous bleed from bridging veins
- Can fill subdural spaces
old, minor head injury days before as venous blood flow is slow, confusion
typical history of subarachnoid haemorrhage
- Secondary to trauma or spontaneous rupture of blood vessel e.g. aneurysm
- Usually a branch of the Circle of Willis (arterial circuit responsible for supplying brain structures)
- Blood leaks into subarachnoid space, mixing with CSF- sudden, often fatal
worst headache ever had, nauseous vomiting, meningism, patient often has hypertension, sudden
typical history of subapneurotic haemorrhage
scalp
Subgaleal hemorrhage is a rare but potentially lethal condition found in newborns. 1. It is caused by rupture of the emissary veins, which are connections between the dural sinuses and the scalp veins. Blood accumulates between the epicranial aponeurosis of the scalp and the periosteum
where does blood cpollect in extradural haemorrhage
Is a collection of blood in the ‘potential’ space between the skull and the outer protective lining that covers the brain (the dura mater).
extradural haemorrhage on CT
biconvex
associated wuth fracture (75%)
subdural haemorrhage usually associated with
traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. It usually results from tears in bridging veinsthat cross the subdural space.
subdual haemorrhage on CT
crescentic
chronic subdural haemorrhage
confusion
acute subdural haemorrhage
e.g. car crash
subarachnoid haemorrhage is due to what sort of bleed
e.g. intracerebral aneurysm- circle of willis
subarachnoid on CT
- 93% picked up if within 24 hours
- 100% if within 6 hours
- Lumbar puncture if CT inconclusive: sample CSF to identify presence of blood (GHb degradation products)
central hyperdensity within subarachnoid
Extradural hematoma
extradural hematoma occurs when blood accumulates between your skull and the outermost covering of your brain.
It typically follows a head injury, and usually with a skull fracture e.g. at the pterion–> bleeding of the MMMA. High-pressure bleeding is a prominent feature. If you have an epidural hematoma, you may briefly lose consciousness and then regain consciousness.
Subdural hematoma
A subdural hematoma is a collection of blood on the surface of your brain.
It’s typically the result of your head moving rapidly forward and stopping, such as in a car accident. However, it could also suggest abuse in children. This is the same type of movement a child experiences when being shaken.
A subdural hematoma is more common than other ICHs in older people and people with history of heavy alcohol use.
Subarachnoid hemorrhage
A subarachnoid hemorrhage is when there’s bleeding between the brain and the thin tissues that cover the brain. These tissues are called meninges. The most common cause is trauma, but it can also be caused by rupture of a major blood vessel in the brain, such as from an intracerebral aneurysm.
A sudden, sharp headache usually comes before a subarachnoid hemorrhage. Typical symptoms also include loss of consciousness and vomiting.
