Neck Lumps

Question 1

By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness

Answer 1

Reactive lymphadenopathy

Question 2

Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly

Answer 2

Lymphoma

Question 3

May be hypo-, eu- or hyperthyroid symptomatically
Moves upwards on swallowing

Answer 3

Thyroid swelling

Question 4

More common in patients
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected

Answer 4

Thyroglossal cyst

Question 5

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough

Answer 5

Pharyngeal pouch

Question 6

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age

Answer 6

Cystic hygroma

Question 7

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood

Answer 7

Branchial cyst

Question 8

More common in adult females
Around 10% develop thoracic outlet syndrome

Answer 8

Cervical rib

Question 9

Pulsatile lateral neck mass which doesn’t move on swallowing

Answer 9

Carotid aneurysm

Question 10

A painless masses but occasionally may compress the vagus or hypoglossal nerves causing:

• Dysphagia
• Hoarseness
• Stridor
• Weakness of the tongue.

They are more common in people living at high altitude. The majority (90%) are spontaneous, of which 5% are bilateral, but in familial cases (10%), 30% are bilateral. Treatment is surgical excision.

Answer 10

Carotid body tumour

Question 11

Name the 2 most common parotid tumours and how they may present different clinically?

Answer 11

• Parotid pleomorphic adenoma - most common - slow growing.
• Parotid adenolymphoma - second most common
  
  • A.K.A. Warthin’s tumour
  • Strong associated with smoking
  • More common in men.
  • Slow growing.

Both are benign

Question 12

A 43-year-old woman is seen in the Emergency department with a 4 x 3 cm painful swelling beneath her left mandible. It has been rapidly increasing in size over the previous week and the pain has increased as the lesion has enlarged.

Answer 12

Submandibular cannaliculi

The submandibular gland is the most common site for calculi (85%), this being due to the higher calcium content in its saliva compared to the other glands. Calculi are seen equally in men and women and can be seen at any age. Some stones can be removed by opening Warthin’s duct and milking the stone along but many require excision of the gland.