Neck Lumps Flashcards
What are the differentials for a lateral neck lump?
Artery - Carotid artery aneurym, subclavian artery aneurysm, chemodectoma
Nerves - Neurofibroma, schwannoma
Lymphatics - Lymphangioma
Lymph nodes
Larynx - Laryngocele
Pharynx - Pharyngeal pouch
Branchial arch remnant
Skin
What is the most common cause of lateral neck lumps in children?
75% are benign
Congenital and inflammatory are most common
DD weighted in favour of thyroglossal cysts, branchial cleft cysts, cystic hygromas and lymphadenitis
What is the most common cause of lateral neck lumps in adults?
As many as 75% of lateral neck lumps are malignant
Of these 80% are metastases
What questions should be asked about lateral neck lumps
How long had it been there?
Has lump got bigger, smaller or stayed the same size?
Is it painful?
Other lumps?
What are the three main things you are trying to find out when palpating a lateral neck lump?
Is it superficial or deep?
Is it in the anterior or posterior triangle of the neck?
What is its relationship to muscle?
(Nod head/shrug shoulders against resistance)
What are the differentials if a lateral lump is in the anterior triangle?
Branchial cyst/sinus/fistula Carotid body tumour Carotid artery aneurysm Salivary gland Laryngocele
What are the differentials if a lateral lump is in the posterior triangle?
Cystic hygroma
Cervical rib
Pharyngeal pouch
Subclavian artery aneurysm
What other features of a lateral neck lump should be characterised?
Tender and/or warm?
Solid or fluctuant?
Is it pulsatile?
Is it motile?
What examinations should be performed if infectious lymphadenopathy is suspected?
Examine throat and all lymph nodes of the head and neck
What examinations should be performed if malignant lymphadenopathy is suspected?
Examine their scalp, face, ears, mouth and nose for a potential squamous cell carcinoma or melanoma
Examine all the lymph nodes of the head and neck
Examine the breast and the lungs
Full abdo if Virchow’s node is palpable
Fibreoptic endoscopy to examine the nasal cavity, nasopharynx, oropharynx and hypopharynx
What do you examine if there is a parotid swelling?
Examine the integrity of the facial nerve (palsy may result from an invasive malignant tumour)
Examine the oral cavity for displacement of the soft palate by a tumour involving the deep lobe of the parotid
What are the red flag signs for malignant lymph nodes?
Tethered to surrounding tissue
Hard
What are the two routine investigations to assess if a lymph node is malignant?
Ultrasound
Fine needle aspiration
What is the ‘coffin corner’?
A region at the posterior tongue/floor of the mouth where it is notoriously difficult to detect tumours
What are the thyroid differentials of a midline neck lump?
Physiological goitre Multinodular goitre Graves' disease Hashimoto's thyroiditis Thyroglossal cyst Thyroid cyst Solitary adenoma Carcinoma
What are the non-thyroid differentials for a midline neck lump?
Lipoma Dermoid cyst Epidermal cyst Abscess Lymphoma
What are the main questions to ask a patient with a midline neck lump?
How long has the lump been there for?
Has it changed size?
Is the lump painful?
Any other lumps?