NECK LUMPS Flashcards
What is the differential diagnosis for midline neck masses?
Submental reactive lymphadenopathy
Plunging ranula
Thyroglossal cyst
Thyroid mass (goitre)
Pharyngeal pouch
What is the differential diagnosis for lateral neck masses?
Reactive lymphadenopathy
Lymphoma
Salivary gland enlargement
Branchial cyst
Cystic hygroma
Carotid aneurysm
Thyroid mass
Cervical rib
What is the most common cause of neck swelling?
Reactive lymphadenopathy
What is the mnemonic for remembering the causes of lymphadenopathy?
Mnemonic: HODGKINS DISEASE
H aematological: Hodgkins lymphoma, NHL, Leukaemia
O ncological: metastases
D ermatopathic lymphadenitis
G aucher’s disease
K awasaki disease
I nfections: TB, glandular fever, Syphilis
N iemann Pick disease
S erum sickness - reaction to proteins in antiserum derived from a non-human animal source
D rug reaction (phenytoin)
I mmunological (RA)
S arcoidosis
E ndocrinological (Hyperthyroidism)
A ngioimmunoplastic lymphadenopathy
S LE
E osinophilic granulomatosis
What are the features of a neck lump that would make you suspect lymphoma?
Rubbery, painless lymphadenopathy
Some report lump becomes painful when drinking alcohol
Associated with nights sweats and splenomegaly
What are the features of a neck lump that would make you suspect a thyroid swelling?
Moves upwards when patient swallows
Symptoms of hypo- or hyper-thyroidism
What are the features of a neck lump that would make you suspect a thyroglossal cyst?
Usually midline, between isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of tongue
May be painful if infected
More common in patients under 20
What are the features of a neck lump that would make you suspect a pharyngeal pouch?
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration, chronic cough and halitosis (bad breath)
More common in older men
What is a pharyngeal pouch?
A pharyngeal pouch is a posteromedial diverticulum through Killian’s dehiscence. Killian’s dehiscence is a triangular area in the wall of the pharynx between the thyropharyngeus and cricopharyngeus muscles. It is more common in older patients and is 5 times more common in men
What are the features of a neck lump that would make you suspect a cystic hygroma?
Typically found in left posterior triangle of the neck
Most are evident at birth, around 90% present before 2 years of age
What is a cystic hygroma?
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
What are the features of a neck lump that would make you suspect a branchial cyst?
Oval, mobile cystic mass
Develops between sternocleidomastoid muscle and pharynx
Usually present in early adulthood
What is a branchial cyst?
A congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.
What are the features of a neck lump that would make you suspect a cervical rib?
Hard, non mobile
Situated above first rib
What is a cervical rib?
Extra rib which arises from the seventh cervical vertebra. Sometimes known as “neck ribs”, their presence is a congenital abnormality located above the normal first rib. A cervical rib is estimated to occur in 0.6% (1 in 150 people) to 0.8% of the population. People may have a cervical rib on the right, left or both sides.
