Neck Lumps

Question 1

Assessment of neck lumps

Answer 1

-History and examination
-Imaging
=USS
=CT
=MRI
-FNA/ core biopsy
-Open/ excision biopsy

Question 2

Examples of neck lumps

Answer 2

-Lymph nodes
-Parotid
-Carotid
-Branchial cyst
-Thyroid
-Thyroglossal cyst
-Dermoid
-Submandibular
-Neuromas

Question 3

Considerations for lymph nodes

Answer 3

-Anywhere except midline
-Single/ multiple
-Soft mobile/ hard fixed
-Associated symptoms

Question 4

Management of lymph nodes

Answer 4

-Head and Neck Lump clinic
=Full ENT examination including upper aerodigestive endoscopy
=USS with FNA as appropriate
-CT/MRI if required
-Treat causative process

Question 5

Parotid mass

Answer 5

?

Question 6

Causes of carotid mass

Answer 6

-Carotid aneurysm
-Carotid body tumour

Question 7

Describe branchial cyst

Answer 7

-Young adult
-Cystic swelling anterior to mid third of sternomastoid
-Careful assessment to exclude cystic degeneration in a malignant metastasis H&N lump clinic
-Surgical excision

Question 8

Describe thyroid mass

Answer 8

-Clinical: low midline and paratracheal, move up on swallowing
-Multiple causes requiring careful clinical assessment
-Clinical
-Bloods
-USS
-FNA
-Treatment according to cause

Question 9

Describe thyroglossal cyst

Answer 9

-Clinical: midline, elevates on protrusion of tongue
-Thyroid function assessment
-Surgical excision if problematic

Question 10

Describe submandibular mass

Answer 10

-Pathology: stones/ obstruction, siladenitis, tumour
-Clinical: submandibular gland not lymph node? Bimanual intra-oral palpation, assess submandibular duct
-Management: USS/ X ray (stones), FNA, surgical excision

Question 11

Neck lump red flags

Answer 11

-Hoarseness
-Dysphagia
-Neck lump
-Otalgia (ear pain)
-Throat pain
-Ulceration
-Stridor
=Symptoms for more than 3 weeks in clinical context= malignant suggestive= urgent referral