Neck Lumps Flashcards
Ddx lateral lumps in the neck
Lymph node Solitary thyroid nodule Sebaceous cyst/lipoma Cystic hygroma/branchial cyst Vascular: aneurysm, carotid body tumour Salivary glands Nerve: neurofibroma
Ddx Midline lumps in the neck
Goitre
Thyroglossal cyst
Indications for thyroid goitre surgery
Failure of medical treatment
Large goitre
Patient choice
Intolerance of medication (eg rashes - 1/20 get w/ carbimazole)
Complications of thyroid goitre surgery
(Acute, early, rare) Bleeding Thyroid crisis (fast afib/pul oedema/hyperthermia) (Damage to local structures) Hypoparathyroidism- hypocalcaemia Damage to recurrent laryngeal nerve (Common) Late hypothyroidism Recurrent hyperthyroidism
If you were assisting thyroid surgery how would you help prevent bleeding?
Tie off dual blood supply (superior thyroid a. from external carotid and inferior thyroid a. from subclavian a.)
How would you avoid damage to recurrent laryngeal nerve?
Stay anterior to pretrachael fascia
Commonest large goitre
Multinodular goitre
Test for retrosternal goitre
Pemberton’s test
Patient raises arms and holds above head -> pink face -> temp obstruction of SVC
Embryological remnant cysts?
Thyroglossal cyst (mid line, moves with sticking out tongue) Cystic hygroma (on left, cavernous lymphangioma, there from birth or early childhood, brilliant translumination, usually in posterior triangle) Branchial cyst (lateral from deep behind upper border of Sterno-mastoid at level of hyoid bone, from second brachial cleft, teens/young adults, usually transluminates, fluid rich in cholesterol crystals, risk of damage to 12th CN)
Carotid aneurysm
Localised, pulsating and LATERALLY expansile
Carotid cyst
Localised, pulsating, VERTICALLY expansile
Carotid body tumour (chemodectoma)
Slowly enlarging firm mass
High in neck, arising from the carotid bifurcation
Hard, solid, nontransluminable, pulsating, not expansile
Causing splaying of internal and external carotids
Causes of lymphadenopathy
Acute infection Chronic infection Neoplastic local spread Distant spread Hodgkins, non-Hodgkins, CLL
Causes of cervical nodes - local
Acute infection - tonsillitis, otitis externa
Chronic infection - cold abscess of TB
Neoplastic - local spread from head and neck
Distant spread from breast, lung, abdomen
Causes of cervical nodes - generalised
Acute infection - acute mononucleosis
Chronic infection - TB, syphilis, HIV
Neoplasms - Hodgkins, non-Hodgkins, CLL
Lipoma
Subcutaneous Soft Mobile, not attached to skin Fluctuant Anywhere but palms, soles, scalp
Epidermoid (sebaceous) cyst
Smooth, round Attached to skin at punctum Mobile over deep tissues Firm All sites except palms and soles
Neurofibromatosis
Autosomal dominant
Solitary or generalised
Check for axillary freckling plus cafe au lait spots
Type 2 associated with acoustic neuroma
Check facial nerve, corneal reflex and hearing
Types of salivary glands
Parotid, submandibular, sublingual
Causes of enlarged salivary glands
Acute viral infection Acute bacterial infection - staph 2o to dehydration, DM, malnutrition, dry mouth of phenothiazines, alcoholism, pancreatitis Calculi and distal infection Sjögren's syndrome eg with RA Tumours
Parotid tumour
Pleomorphic adenoma
Suspect malignancy if pain, fixation, VII etc
Awlays test facial nerve
Parotid duct by 2nd molar
Submandibular gland
Submandibular duct under tongue on either side of frenulum
Bimanual Palpation of submandibular distinguishes from lymph node
