neck lumps Flashcards
Landmarks of the Neck: bones
Mastoid process
Mandible
Hyoid (C3)
Clavicles (_supra-sternal notch/fossa)
Landmarks of the Neck: muscles
Sternocleidomastoid
Trapezius
Landmarks of the Neck: glands
Thyroid
Parotid
Submandibular
Sublingual
Landmarks of the Neck: other
- laryngeal prominence (Adam’s apple C4)
- Cricothyroid Membrane (C5-C6)
- Trachea (C6)
nerves of the neck
- cervical plexus (C1-C4)
- Brachial plexus (C5-T1)
- Phrenic
- Vagus
- Accessory
categorising neck lumps: superficial structures
- sebaceous cyst
- lipoma
- abscess
- dermoid cyst
categorising neck lumps: midline structures
- thyroglossal cysts
- thyroid swelling
- laryngeal swelling
- dermoid cyst
- submental lymph nodes
- chondroma of thyroid cartilage
- radula
categorising neck lumps: lateral structures - anterior triangle
- thyroid lobe swellings
- pharyngeal pouch
- brachial cyst
- submandibular lymph gland pathology
- lymphadenopathy
- parotid gland swelling (mumps/tumour)
- laryngocoele
categorising neck lumps: lateral structures - posterior structures
- lymphadenopathy (malignancy, TB)
- carotid artery aneurysm
- carotid body tumour
- cystic hygroma
- cervical rb
- torticollis
Lymphangioma
Degenerative lesions derived from lymphatics. Usually present from birth though can present in young adults. Appear anywhere in head and neck, feel cystic and transilluminate, may remain static or involute but often grow with child and can comprimise airway, eye forcing surgical intervention.
Microcystic or macrocystic – can be dealt with by intralesional injection with OK432 as a sclerosant agent
Thyroglossal cyst
Cyst along the thyroid tract as it descends. Moves on swallow and tongue protrusion.
Branchial cysts
are cystic masses that occur most commonly in young adults
They are usually found at the upper third of SCM unilateral and painless.
They can get recurrently infected.
4 theories exist – branchial appaatus theory, cervical sinus theory, thymppharyngeal dust theory and inclusion theory
cervical lymphadenopathy
Generally speaking. Cervical lymphadenopathy is either infection or malignancy.
Malignancy is either primary (lymphoma or leukiemia) or a metastasis from another H&N site.
Weird infections: TB/Cat scratch/brucellosis/toxoplasmosis/HIV
Systemic conditions:kawasaki/sarcoid
T.I.N.E.D A C.C.A.N
causes of neck lumps
T- Trauma I- infective N- neoplastic E - Endocrine D- Drugs/allergies
C- Connective tissue/fascia
C- congenital
A- Arterio-venous/Lymphatics
N - Neurological
T - trauma
- Fractures/muscle evulsion
- Haematoma
- Reactive oedema
I- infective
- Insect bite
- TB
- Cat Scratch disease (Bartonella)
- Mumps
- Retropharyngeal abscess
- Neck abscess
- Lymphadenopathy (Glandular fever)
N- neoplastic
- Squamous Cell carcinoma
- Lymphoma
- Thyroid cancer
- Salivary gland tumour
E - Endocrine
- goitre
- autoimmune
D- Drugs/allergies
- iodine deficiency
- anaphylaxis (laryngeal oedema)
C- Connective tissue/fascia
- Dermoid cyst
- Sebaceous cyst
C- congenital
- Thyroglossal cyst and fistuale
- Cystic hygroma
- Branchial cyst
- Dermoid Cyst
A- Arterio-venous/Lymphatics
- Cystic hygroma (congenital)
- Branchial cyst (congenital)
- Carotid body tumour
N - Neurological
- Torticollis (Wry Neck)
general history
PC – Swelling in neck, pain, weight loss, fatigue, dysphagia, dysphonia, fever, malaise
HPC – SOCRATES, site, onset, change in size, single/multiple, pain, referred pain ?pregnant
PMH – other relevant conditions, ?autoimmune –RA/sjrogens, previous operations,
DH and Allergies
FH – hereditary conditions
SH – Smoker – risk of ca, alcohol, occupation
Radiation exposure, Previous malignancy , trauma, recent travel, insect/animal bites
history: associated symptoms
- Dysphagia,
- odynophagia,
- sore throat,
- dysphonia,
- otalgia,
- nasal obstruction,
- wt loss,
- anorexia,
- malaise,
- night sweats
Lump Specific history
Classification: Onset, Site, Size, unilateral/bilateral, single/multiple, pain, fluctuance
Risk Factors
modifiable (smoking, alcohol, occupation, travel, no vaccinations)
non-modifiable (age, sex, previous conditions, FH, previous radiation exposure)
Associated Symptoms ENT specific (otalgia, dysphonia, sore throat, nasal obstruction)
General (Dysphagia, weight loss, night sweats, tremor, palpitations, temperatures)
thyroid specific history
Appearance: Thyroid facies, eye signs, bilateral neck swelling, tremor, weight loss/gain
Psychiatric: Mood changes
GI: dysphagia, odynophagia, bowel habit, weight, appetite
GU: Menstrual disturbance
Respiratory: breathing difficulties/voice change
Cardiac: palpitations
Other: autoimmune conditions, malaise, restless
examination
Ears, nose and throat
Neck examination including lumps
Lymph nodes
Thyroid examination
End pieces (systemic LN examination, other systems, tests, referrals)
thyroid Examination
Consent and exposure
Inspect – front, side and back, noting lump, neck veins, thyroid status – face, hands, eyes, shins
Water test– goitre moves up
Protrude tongue – thyroglossal cyst moves up
Palpation from behind – one side then other, smooth vs nodular, unilateral or bilateral, swallow water and protrude tongue, LN exam
Percuss – down sternum for retrosternal goitre
Auscultation – thyroid bruit in graves disease
Reflexes – brisk in hyper, slow relaxing in hypo
End pieces – Full ENT examination, examine for systemic lymphadenopathy, routine investigations including TFTS +/- USS scan and FNA/core biopsy
Investigations
Bloods – FBC, CRP, TFTs, Calcium, Calcitonin, PTH, antibodies
Radiology – USS, CT, MRI
Biopsy – FNA, core biopsy under LA or GA
Referral to endocrine or ENT specialist
