neck lumps Flashcards
anterior triangle borders
superior: mandible
medial: neck midline
lateral: SCM
posterior triangle borders
inferior: clavicle
medial: SCM
posterior: trapezius
2 week wait referral for…
- unexplained lump in someone ≥45yrs
- persistent unexplained neck lump at any age
if lump is growing in size
USS
- within 2wks if ≥25yrs
- within 48hrs if < 25yrs
lymphadenopathy
enlarged lymph noes
can be
- reactive
- infective
- inflammatory
- malignant
lymphadenopathy - reactive
viral UTRI
tonsilitis
dental infection
lymphadenopathy - infected
TB
HIV
infectious mononucleosis
lymphadenopathy - inflammatory
SLE
sarcoid
lymphadenopathy - malignancy
lymphoma
leukaemia
metastasis
lymphadenopathy - features suggestive of malignancy
unexplained persistently enlarged esp >3cm abnormal shape hard or rubbery non-tender fixed to skin or underlying tissues assoc symptoms: night sweats, weight loss, fever, fatigue
what happens if treat someone with infective mononucleosis with amoxicillin
intensely itchy maculopapular rash
infective mononucleosis - Ix
monospot test**
also IgM (acute) and IgG (immunity) for EBV
infective mononucleosis - Mx
avoid alcohol - risk liver impairment
avoid contact sport - risk splenic rupture
reasons for salivary gland enlargement
stones
infection
tumours
carotid body
structure located above carotid bifurcation
contains glomus cells which are chemoreceptors
Carotid Body Tumours
formed by excessive growth of glomus cells
aka paraganglioma
most benign
Carotid Body Tumours - features
slow growing lump upper anterior triangle of neck painless pulsatile assoc with bruit mobile side-to-side but not up and down
Carotid Body Tumours - characteristic finding on imaging
splaying of internal and external carotid arteries
Lyre sign
Carotid Body Tumours -Mx
surgical removal
thyroglossal cyst
persistent of thyroglossal duct
thyroglossal cyst - key differential diagnosis
ectopic thyroid tissue
thyroglossal cyst - features
midline of neck mobile non-tender soft fluctuant
thyroglossal cyst - key feature
move up and down with tongue movement
due to connection between thryoglossal duct and base of tongue
thyroglossal cyst - Ix and Mx
USS or CT
surgical removal
branchial cyst
congenital abnormality where 2nd branchial cleft fails to form properly
leaves a space surrounded by epithelial tissue in lateral asppect of neck
can fill with fluid –> branchial cyst
branchial cyst - features
soft, round cystic swelling
between angle of haw + SCM in anterior triangle neck
branchial cyst - presentation
tend to present >10yrs when cyst becomes noticeable or infected
branchial cyst - Mx
conservative
surgical excision - recurrent infection, diagnostic doubt, other problems
