Neck Lumps

Question 1

Differentials of neck lumps in adults

Answer 1

Normal structures, skin abscess, lymphadenopathy, tumour, lipoma, goitre, salivary gland stones or infection, carotid body tumour, haematoma, thyroglossal cysts, branchial cysts

Question 2

Differentials of neck lumps in children

Answer 2

Cystic hygromas, dermoid cysts, haemangiomas, venous malformation

Question 3

Neck lump red flags

Answer 3

Unexplained neck lump in someone aged 45 or over.
Persistent unexplained neck lump at any age

Question 4

Blood test investigations

Answer 4

FBC and blood film - leukemia and infection.
HIV test.
Monospot test for EBV antibodies - gladnular fever.
Thyroid function tests (goitre/thyroid nodules).
Antinuclear antibodies - SLE.
Lactate dehydrogense (LDH) - Hodgkin’s lymphoma

Question 5

Imaging for investigations

Answer 5

US - firstline for neck lumps
CT or MRI
Nuclear medicine scan - toxic thyroid nodules or PET scans for metastatic cancer

Question 6

Biopsy investigations

Answer 6

Fine needle aspiration.
Core biopsy
Incision biopsy
Removal of lump

Question 7

Types of lymphadenopathy groups (4)

Answer 7

Reactive, infected, inflammatory, malignancy

Question 8

Causes of reactive lymphadenopathy

Answer 8

Swelling caused by viral upper respiratory tract infections, dental infections, tonsilitis

Question 9

Causes of infected lymphadenopathy

Answer 9

Tuberculosis, HIV, infectious mononucleosis

Question 10

Causes of inflammatory lymphadenopathy

Answer 10

Systemic lupus erythematous, sarcoidosis

Question 11

Causes of malignant lymphadenopathy

Answer 11

Lymphoma, leukaemia, metastasis

Question 12

Which cervical lymph nodes are the most concerning

Answer 12

Supraclavicular nodes - malignancy in chest or abdomen