Neck Lumps Flashcards
neck lumps in people up to 40 years
90% benign
neck lumps in people over 40 years
rule of 80s
in an adult over 40 years with suspicious lateral neck mass
80% malignant
80% represent metastasis
80% of those metastasis are from above the clavicle
required physical examination
complete head and neck examination including cranial nerve exam, otoscopy, neck palpation
emphasis on location, mobility and consistency
diagnostic tests required
fine needle aspiration biopsy
ultrasonography
computed tomography
magnetic resonance imaging
radio nucleotide scanning
using ultrasonography to investigate
ideal initial imaging investigation
identifies solid vs. cystic massess
identifies congenital cysts from solid nodes/tumours
non invasive
FNA biopsy to investigate
standard of diagnosis
indicated for any neck mass that is not an obvious abscess or for diagnosis of inflammatory mass that persists after a two week course of antibiotics
CT for investigation
distinguish cystic from solid
can tell extent of lesion
can tell vascularity if you use contrast
may detect primary cancer
MRI investigation
similar information as CT
better for upper neck and skull base
vascular delineation with infusion
types of congenital and developmental masses
epidermal and sebaceous cysts
branchial cleft cysts
thyroglossal duct cyst
vascular tumours
branchial cleft cysts
present in older children or young adults often following URI
2nd cleft most common
1 cleft less common
3rd and 4th clefts rarely reported
what does a branchial cleft cyst look like
smooth, fluctuant mass underlying the SCM
skin erythema and tenderness if infected
how do you treat branchial cleft cysts
initial control of infection
surgical incision, including tract
thyroglossal duct cyst
most common congenital neck mass
50% present before age 20
what does a thyroglossal duct cyst look like
usually midline or near midline
usually just inferior to hyoid bone
elevates on swallowing/protrusion of tongue
treatment of thyroglossal duct cyst
surgical removal after resolution of any infection
lymphoma
more common in children and young adults
80% of children with Hodgkin’s have a neck mass
signs and symptoms of lymphoma
lateral neck mass only
discrete, rubbery, non-tender
fever
hepatosplenomegaly
diffuse adenopathy
lymphoma disgnosis
FNAB - first line diagnostic test
may require open excisions biopsy for sub typing of lymphoma
full workup - Ct scans of chest, abdomen, head and neck, bone marrow biopsy
salivary gland tumours
enlarging mass anterior/inferior to ear or at the mandible angle
highly suspicious
benign ones will be asymptomatic except for the mass
malignant ones will have rapid growth, skin fixation and cranial nerve palsies
lipoma
soft, ill defined mass
usually >35 years of age
asymptomatic
clinical diagnosis
epidermal and sebaceous cysts
most common congenital/developmental mass
older age groups
how to treat epidermal and sebaceous cysts
excisions biopsy
vascular tumours
lymphangiomas and hemangiomas
usually within first year of life
hemangiomas often resolve spontaneously, while lymphangiomas remain unchanged
CT/MRI may help define extent of disease
inflammatory disorders causing neck lumps
lymphadenitis and granulomatous lymphadenitis
lymphadenitis
very common
tender node with signs of systemic infection
FNAB indicators for lymphadenitis (paediatric)
actively infectious condition with no response
progressively enlarging
solitary and asymmetric nodal mass
supraclavicular mass
persistant nodal mass without active infection
granulomatous lymphadenitis
infection develops weeks to months
minimal systemic complaints or findings
firm, relatively fixed node with infection of skin
appearance of granulomatous lymphadenitis
firm, relatively fixed node with infection of skin
common aetiologies of granulomatous lymphadenitis
TB, atypical TB, cat scratch fever, actinomycosis, sarcoidosis
what is the main concern in an adult with a new lateral neck mass
malignancy
name the most effective tool to determine aetiology of a lack mass
fine needle aspiration biopsy
