Neck lumps

Question 1

Neck triangles

Answer 1

Anterior triangle
Posterior triangle
Carotid triangle

Question 2

Borders of the anterior triangle

Answer 2

Medial - imaginary midline

Lateral - Anterior border of the SCM

Superior - Mandible

Question 3

Borders of the posterior triangle

Answer 3

Medial - Posterior border of the SCM

Posterior - trapezius

Inferior - clavicle

Question 4

Borders of the carotid triangle

Answer 4

Superior - posterior diagastric muscle

Lateral - Anterior border of the SCM

Medial - Infrahyoid muscle - omohyoid muscle

Question 5

Causes of neck lumps

Answer 5

Skin abscess

Lymphadenopathy (enlarged lymph nodes)

Tumour (e.g., squamous cell carcinoma or sarcoma)

Lipoma

Goitre (swollen thyroid gland) or thyroid nodules

Salivary gland stones or infection

Carotid body tumour

Haematoma

Thyroglossal cysts

Branchial cysts

Question 6

Causes of neck lumps in young children

Answer 6

Cystic hygromas

Dermoid cysts

Haemangiomas

Venous malformation

Question 7

History for neck lumps

Answer 7

Symptoms - SOCRATES

How quickly it has grown

Night sweats -lymphoma

RFs for that condition (e.g. FHx, age and smoking status)

Question 8

Examination of neck lumps

Answer 8

Location

Size and shape

Consistency

Mobile or tethered to the skin or underlying tissues

Skin changes

Warmth and tenderness - infection

Pulsatile - carotid body tumours

Movement with swallowing or sticking their tongue out

Transilluminates with light

Question 9

How does a malignant neck lump feel

Answer 9

Hard, matted and rubbery, non mobile

Question 10

Skin changes

Answer 10

Erythema

Tethering

Ulceration

Question 11

Neck lump that moves with swallowing

Answer 11

Thyroid lumps

Question 12

Neck lump that moves when sticking your tongue out

Answer 12

Thyroglossal cysts

Question 13

Neck lump that transilluminates with light

Answer 13

Cystic hygroma – usually in young children

Question 14

Other examinations for neck lumps

Answer 14

ENT infections - reactive lymph nodes

Weight loss - malignancy or hyperthyroidism

Skin pallor and bruising - leukaemia

Focal chest sounds - lung cancer

Clubbing - lung cancer

Hepatosplenomegaly - leukaemia

Question 15

Neck Lump Red-Flag Referral Criteria

Answer 15

2ww referral for:

• Unexplained neck lump in someone aged 45 +
• Persistent unexplained neck lump at any age
• if the USS is suggestive of soft tissue sarcoma

Question 16

USS for a neck lump

Answer 16

USS neck - if growing in size

Within 2 weeks in patients 25 + and within 48 hours in patients under 25

Question 17

Investigations for a neck lump

Answer 17

Depends on cause:

FBC and blood film - leukaemia and infection

HIV test

Monospot test or EBV antibodies for infectious mononucleosis

TFTs - goitre or thyroid nodules

Antinuclear antibodies -SLE

LDH - non-specific tumour marker for Hodgkin’s lymphoma

Imaging

Biopsy

Question 18

Type of biopsy

Answer 18

Fine needle aspiration cytology

Core biopsy

Incision biopsy – cutting out a tissue sample with a scalpel

Removal of the lump

Question 19

Imaging for neck lumps

Answer 19

• USS
• CT or MRI scans
• Nuclear medicine scan (e.g. for toxic thyroid nodules or PET scans for metastatic cancer)

Question 20

Causes of lymphadenopathy

Answer 20

Reactive lymph nodes - viral URTI, dental infection or tonsillitis

Infected lymph nodes (e.g. TB, HIV or infectious mononucleosis)

Inflammatory conditions (e.g. SLE or sarcoidosis)

Malignancy (e.g. lymphoma, leukaemia or metastasis)

Question 21

Enlarged supraclavicular nodes

Answer 21

Virchow’s node - indicative of chest/abdomen malignancy