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Head and neck > Neck lump differentials > Flashcards

Neck lump differentials Flashcards

1
Q

what should you look for in a history when being presented with a neck lump

A
  • history
    • age ( in cbildren enlarged lympnode is likely secondary to infection
    • duration, progression, associated symptoms and signs e.g. red flags
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2
Q

what should look for when examining a neck lump

A
  • relate locatio to knowledge of underlying structures
  • anteriro or psoteiror triagnle? Mdiline or laterally placed?
  • movement with swallowing and sticking out tongue
  • palpation
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3
Q

features to look for when palpating neck tumour

A
  • 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
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4
Q
A
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5
Q

what are some of the possible causes of neck lumps

A
  • 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
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6
Q

name some superifical causes of enck lumps

A

sebacious cysts, dermoid cyst, lipoma

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7
Q

name some causes of inflammatory/infective lymph nodes

A

tonsilitis, mouth ulcers

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8
Q

name some congenital causes of nekc lumps

A

thyroglossal cysts, branchial cysts, laryngocoele

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9
Q

thyroid pathology can be

A

malignant or benign

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10
Q

primary cancer of the lymph node

A

lymphoma

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11
Q

secondary malignancy of the neck lymph node

A

metastatic

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12
Q

supraclavicular node drain the

A

thorax and abdomen- Virchows node (think of johnny)

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13
Q

salivary gland patholgoy

A

calculus, infection, tumour

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14
Q

other causes of neck lumps

A

chronic infection (TB, HIV)

carotid artery aneurysm

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15
Q

Lymphadenopathy is very common case for neck lumps. They can be caused due to:

A
  1. Infection (most common)
    • Tender and mobile
  2. Malignancy
    • Hard, matted, non-tender
    • Or rubbery, moviel and fast growing
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16
Q

relationship between superifical and deep lymph nodes

A

superfical lymph nodes (more readily palpable) drain into the deep lymph nodes within the carotid sheath

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17
Q

deep lymph nodes most associated with

A

internal jgual vein along its length within the carotid sheath

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18
Q

Key areas for lymph nodes on the face, scalp and neck

A
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19
Q

what tests could you do on a pt that presents with a neck lump

A
  • FBC
  • virology serology
  • chest x-ray
  • throat swab
  • FNAB (fine needle aspiration biopsy)
  • ultrasound
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20
Q

what are some possible differentials for a neck lump apart from lymphoma

A

lipoma, thymoma

21
Q

what area do the supraclavicular nodes drain

A

-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

22
Q

what initital imaging choice for a neck lump and why

A

US

  • can see superficial
  • no radiation
  • can biopsy
23
Q

red flags for lymphadenopathy

A
  • 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)
24
Q

differentials of a lateral neck lump

A

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
25
Q

Branchial cyst

A
26
Q

branchial cyst

A
  • lateral to midline in the anterior triangle
  • in front of SCM (superficial)
  • congenital- remnant of second branchial cleft
  • does not move on swallowing
27
Q
A
28
Q

midlien lymp differentials

A
  • thryoglossal duct cyst
  • dermoid cyst
  • thyroid pathology
  • general lympadenopathy
29
Q

thyroglossal duct cysts

A
  • near hyoid
  • pea sized cyst
  • when the connection between the tongue and thyroid is never lost
  • stick tongue out will move
30
Q

dermoid cyst

A

congenital

will not move on swallowing

31
Q

thyroid pathology

A
  • cancer
  • goitre ( TSH, T3/T4)
  • will move on swallowing
32
Q
A
33
Q

how can you tell the difference between this beign a lipoma and goitre

A
  • cant get fingers around goitre
  • moves up when swallowif if a goitre
34
Q

typical history of extradural haemorrhage

A

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

35
Q

typical history of subdural haemorrhage

A

Venous bleed from bridging veins

  • Can fill subdural spaces

old, minor head injury days before as venous blood flow is slow, confusion

36
Q

typical history of subarachnoid haemorrhage

A
  • 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

37
Q

typical history of subapneurotic haemorrhage

A

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

38
Q

where does blood cpollect in extradural haemorrhage

A

Is a collection of blood in the ‘potential’ space between the skull and the outer protective lining that covers the brain (the dura mater).

39
Q

extradural haemorrhage on CT

A

biconvex

associated wuth fracture (75%)

40
Q

subdural haemorrhage usually associated with

A

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.

41
Q

subdual haemorrhage on CT

A

crescentic

42
Q

chronic subdural haemorrhage

A

confusion

43
Q

acute subdural haemorrhage

A

e.g. car crash

44
Q

subarachnoid haemorrhage is due to what sort of bleed

A

e.g. intracerebral aneurysm- circle of willis

45
Q

subarachnoid on CT

A
  • 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

46
Q

Extradural hematoma

A

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.

47
Q

Subdural hematoma

A

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.

48
Q

Subarachnoid hemorrhage

A

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.

49
Q
A

Head and neck (51 decks)

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