Neck lumps Flashcards
Spot diagnosis + management
- slow-growing lump
- moves with swallowing, but not with tongue protrusion
Goitre (enlarged thyroid gland) - typically beneath thyroid cartilage
Management:
- Asymptomatic - conservative
- Symptomatic (compressive or suspicious for malignancy) - thyroidectomy
(fine needle aspiration if suspicious of cancer)
Spot diagnosis + management
- fluctuating swelling
- moves with swallowing
Thyroid cyst - fluid-filled sac within thyroid gland
Management:
- if recurrent - aspiration or surgery
Spot diagnosis + Management
- firm, hard, fixed lump
- hoarseness of voice
Thyroid nodule - can be adenoma, cysts, or malignancy
(this case suggests cancer)
Management:
- thyroidectomy +/- radioactive iodine
- lifetime thyroxine replacement
What is the investigation of choice for any thyroid nodule/swelling if you are suspicious of cancer?
Thyroid fine needle aspiration
Spot diagnosis + management
- midline neck lump, moves upwards with tongue protrusion
- presented following a recent URTI
Thyroglossal cyst - due to persistent thyroglossal duct
Management:
- USS - to confirm normal thyroid tissue before surgery
- Surgical excision (Sistrunk procedure)
Why do thyroglossal cysts, goitres, and thyroid nodules move with swallowing + why do thyroglossal cysts move with tongue protrusion, but goitres and thyroid nodules do not?
- Thyroid gland and thyroglossal cysts are attached to the trachea –> when you swallow the trachea and larynx move upwards, pulling these structures with them
- Thyroglossal cysts form from the thyroglossal duct (which originally connected the developing thyroid to the tongue)
- This left over connection means that thyroglossal cysts are still attached to the base of the tongue
- When you stick out your tongue, the genioglossus pulls on the foramen caecum –> which pulls on the thyroglossal cyst –> causing it to move up
Spot diagnosis + management
- lateral neck lump (anterior to sternocleidomastoid)
- presented/increased in size following a recent URTI
- painless, but painful during infection
Branchial cyst - located in anterior triangle, arises from embryological remnants of the second branchial cleft in the neck
Management:
- USS +/- FNAC
- Excision if recurrent infections
Spot diagnosis + management
- soft, fluctuant, transilluminable lump
- located in posterior triangle
- present from birth
Cystic hygroma - congenital lymphatic lesion which is typically identified prenatally or at birth, associated with Turner’s and Down syndrome
Management:
- USS/MRI before surgery
- Surgical excision OR Sclerotherapy
Spot diagnosis + management
- soft, tender, mobile lump following infection
- bilateral
Reactive lymphadenopathy - image shows cervical lymphadenopathy
Management:
- usually self-limiting
- treat underlying infection
Spot diagnosis (differentials for 1 and 2) + management
- swelling over parotid region
1. Painful/tender + fever
2. Painless + slow-growing
- Infective
- Neoplastic - pleomorphic adenoma, Warthin’s tumour
Management - surgery if neoplastic
Spot diagnosis (differentials for 1 and 2) + management
- Submandibular swelling, painful, dry mouth
1. Swollen and tender +/- fever
2. Worse after eating
- Sialadenitis - inflammation of the salivary glands, caused by bacterial infection
- Sialolithiasis - salivary gland stone/calculus in Wharton’s duct
Spot diagnosis + management
- firm, rubbery, painless lymphadenopathy
- night sweats, weight loss, and fever (B symptoms)
Lymphoma - Hodgkin’s (good prognosis) OR Non-Hodgkin’s (aggressive)
Management:
- FNAC, excisional biopsy, CT/PET scan
- Chemotherapy
Spot diagnosis + management
- firm, fixed lump, painless
- hoarseness, dysphagia, smoking/alcohol hx
Metastatic SCC
Management:
- FNAC + panendoscopy (to visualise tumour)
- surgery + radiotherapy +/- chemotherapy
Spot diagnosis + management
- slow-growing, pulsatile lateral neck lump, does not move with swallowing
Carotid body tumour (paraganglioma)
Management:
- USS neck
- surgery OR radiotherapy
Spot diagnosis + management
- Pulsatile, expansile swelling with bruit
Carotid artery aneurysm
Management:
- Duplex USS neck
- Surgical repair if symptomatic
Spot diagnosis + management
- soft, painless, slow-growing lump
- mobile (not attached to deeper structures) + no systemic symptoms
Lipoma
Management:
- Reassure - benign
- Surgical excision - if causing discomfort or cosmetic
Spot diagnosis + management
- firm, round lump with a central punctum
- can become red, swollen, and tender if infected
Epidermoid cyst
Management:
- Non-infected: reassure (surgical excision if recurrent)
- Infected/Inflamed: warm compress + analgesia + oral antibx
Spot diagnosis + management
- congenital (present from birth)
- firm, non-tender, slow-growing lump
- does not move with swallowing or tongue protrusion
Dermoid cyst - most common orbital/periorbital tumors found in paediatric population
- Management: surgical excision (to prevent infection or rupture)
Spot diagnosis + management
- soft, compressible swelling in lateral neck
- enlarges with nose-blowing and sneezing / Valsalva manouevre
Laryngocele (rare) - abnormal air sac in the larynx that can cause a bulge in the neck
Management:
- If asymptomatic - observe
- Symptomatic - surgical excision (laryngoelectomy)
- If infected (laryngopyocele) - antibiotics + drainage
