Neck Lumps

Question 1

Branchial Cyst

Answer 1

Congenital 2nd pharyngeal arch abnormality in the anterior border of SCM due to failure of the branchial cleft to close. Can become infected or present as smooth, slowly enlarging masses after URTI–> surgery to remove

Question 2

Thyroglossal duct cyst

Answer 2

A mid-line fibrous cyst which moves up on protrusion of the tongue. are usually painless unless infected. can cause difficulty breathing, dysphagia or dyspepsia

Question 3

Infective Masses

Answer 3

usually in children or young adults, can occur in TB infection
Other infections can cause lymphadenopathy

Question 4

Acute Cervical Lymphoadenopathy

Answer 4

Occurs in viral or bacterial infections in the head, or glandular fever –> can be neoplastic in older adults. can be enlarged in children with no cause

Question 5

Lymphoma

Answer 5

Will usually start with one lymph node being enlarged and hard. Hodgkin’s is rarer, more likely to start in the upper body and can be painful after alcohol

Question 6

Salivary Gland masses

Answer 6

Can be benign –> sialadenitis or parotitis (mumps), infection or abscess, Warthin’s tumour
Malignant –> Adenocarcinoma, mucoepidermoid tumours

Question 7

Warthin’s tumour

Answer 7

papillary cystadenoma, or monomorphic adenoma is a benign tumor of the salivary gland, most often the parotid in older people (60-70yrs)
Strong link to smoking

Question 8

Salivary Gland infection

Answer 8

Usually bacterial after duct blockage (stone) or dehydration

can present with dry mouth, fever, abnormal tastes, inflammation or pain

Question 9

Squamous cell carcinoma

Answer 9

Suspect in all lateral neck lumps in the >40yrs
90% of head and neck cancers –> may present as a chronic mouth ulcer, hoarse voice
RFs–> smoking, drinking and HPV
Prognosis is better for HPV positive cancers

Question 10

Thyroid masses

Answer 10

Inflammatory –> thyroiditis
Degenerative —> thyroid cysts
Thyrotoxicosis
Neoplastic–> benign (adenoma, multinodular goitre) or malignant (carcinoma)

Question 11

Thyroiditis

Answer 11

a general inflammation of the thyroid gland, may be densely fibrotic and fixed (riedel’s thyroiditis) or large, firm and lobulated (hashimoto’s) or diffusely enlarged, symmetrical and non-tender (Gravs’s disease)

Question 12

Thyroid cysts

Answer 12

regions of the gland which have enlarged and filled with fluid, and range from 1cm to very large. often due to a degenerating adenoma . acute swelling may be due to bleeding within the cyst. spontaneously resolve 15%

Question 13

Thyroid nodules

Answer 13

Abnormal growths in the gland which can be solid (may be cancerous) or cystic (usually benign and degenerative) –> invest with ultradound

Question 14

Carotid Body Tumour

Answer 14

AKA chemodectoma or paraganglioma
highly vascular glomus tumor arising from the carotid body at the carotid bifurcation causing ICA/ECA splaying. 40-50s, often women and bilateral in 10%

Question 15

Carotid body tumour presentation

Answer 15

A rounded, slow growing mass on the anterior border of the SCM near the angle of the mandible
can be moved side to side but not up and down
may affect CN IX,X,XI,XII or rarely secrete adrenaline