Neck Lump Imaging

Question 1

What are the history taking for neck lumps?

Answer 1

Gender/age/ethnicity.
Site of lump.
Sizes: changes in size
Lump: palpable, smooth outline, mobility
Length of time present for.
Is there any pain? Is it continuous and intermittent?
Colour of overlying skin.
Temperature
Discharge / sinus
Previous medical history: any history of cancer, any history of radiotherapy, foreign travel? risk factors?

Question 2

What do the 6 levels of the neck correspond to?

Answer 2

Level 1: below the chin
Level 2: superior SCM
Level 3: middle SCM, below hyoid bone
Level 4: lower SCM
Level 5: posterior triangle
Level 6: anterior region

Question 3

What are the main scans we do for diagnosis of neck lumps?

Answer 3

• ULTRASOUND: inexpensive, quick
• MRI: safe (non-radiation), very good for soft tissues
• CBCT
• CT (high dose radiation, wide field of view, soft and hard tissue)

Question 4

List the main causes of a benign neck mass under these categories:
1) Skin
2) Developmental
3) Infection
4) Inflammatory lymphadenopathy
5) Salivary gland
6) Thyroid gland
7) Parathyroid gland
8) Blood vessels
9) Bone

Answer 4

1) Skin
- Epidermoid cyst

2) Developmental
- Thyroglossal duct cyst
- Branchial cyst
- Dermoid cyst

3) Infection
- Dental abscess (ludwings angina)

4) Inflammatory lymphadenopathy
- Necrotising granulomatous disease
- HIV (glandular fever)

5) Salivary gland
- Benign obstruction (stone, stricture, mucous plugs)
- Inflammation (sialadenitis)
- Swelling (ranula, lymph nodes)
- Benign tumour (warthin, pleomorphic adenoma)

6) Thyroid gland
- Benign nodules (hemorrhagic cyst, complex cyst)
- Hyperplasia (graves disease, thyroiditis)

7) Parathyroid gland
- Parathyroid adenoma

8) Blood vessels
- Thrombosis / calcification

9) Bone
- Osteoma, osteomyelitis, osteoradionecrosis, MJORM

Question 5

What is the malignant neck mass differential diagnosis?

Answer 5

Skin
(melanoma, SCC)

Developmental Cyst
(thyroglossal duct cyst can sometimes differentiate into a carcinoma)

Lymph nodes
(Metastasis from head and neck cancer, lymphoma, metastasis from elsewhere)

Salivary gland (adenoid cystic)

Thyroid gland (papillary carcinoma, medullary carcinoma)

Bone (osteosarcoma)