Neck Lumps

Question 1

What are the bacterial causes of cervical lymphadenopathy

Answer 1

• Dental: apical abscess, cellulitis, periodontitis, pericoronitis
• Tonsil, face or scalp infections
• TB
• Syphilis
• Cat-scratch disease
• Lyme disease

Question 2

What are the Viral causes of cervical lymphadenopathy

Answer 2

• Herpetic stomatitis
• Infectious mononucleosis
• HIV
• Childhood fevers

Question 3

What are the parasitic causes of cervical lymphadenopathy

Answer 3

• Toxoplasmosis (parasite from cat poo or infected meat)

Question 4

What primary neoplasms can cause cervical lymphadenopathy

Answer 4

• Hodgkin’s disease
• Non-hodgkin lymphoma
• Leukaemia - esp lymphocytic

Question 5

What secondary neoplasms can cause cervical lymphadenopathy

Answer 5

• Carcinoma - oral, salivary gland, thyroid, oropharyngeal, nasopharyngeal
• Malignant melanoma
• Metastases from gastric and abdominal cancer

Question 6

What are other miscellaneous causes of lymphadenopathy

Answer 6

• Sarcoidosis
• Drug reactions
• Connective tissue diseases
• Recent surgery to mouth or face
• Normal enlarged nodes in children

Question 7

What clinical features can provide guides to the cause of the lymphadenopathy

Answer 7

• Pt age
• Localised or generalised lymphadenopathy
• Level in the neck
• Clinical character of the nodes
• Duration of the swelling
• Associated signs or symptoms

Question 8

Aspects of history that can help identify cause of lump

Answer 8

• History of systemic illness
• Contact with infectious diseases e.g. HIV, syphilis
• Has there been an animal scratch
• Recurrent fever, lassitude, sweats, or anaemia to suggest Hodgkin’s or another lymphoma
• Do any symptoms (e.g. epistaxis or hoarseness) suggest a nasopharyngeal cause
• Any drugs being taken

Question 9

Aspects of examination that can help identify cause of lump

Answer 9

• Check temperature
• Identify the node and its drainage
• Check for dental, other oral, pharyngeal or skin causes in the area
• If possible primary cause is found e.g. oral ulcer, it should be biopsied
• If no local cause is found, consider ear, nose and throat specialist referral for nasopharyngeal cause
• Examine other side of neck, bilateral lymphadenopathy suggests a systemic cause

Question 10

What investigations can be done to neck lumps

Answer 10

• First line; FNA. Gives accurate diagnosis of primary or metastatic neoplasms and many infections including TB
• Blood picture
• Chest radiograph for mediastinal nodes (Hodgkin’s disease, sarcoidosis)
• Serology (glandular fever, toxoplasmosis, HIV)
• Thyroid ultrasound scan and function tests for unsuspected thyroid tumour