Neck Lumps Flashcards
Boundaries of the anterior triangle?
Superiorly - mandible
Medially - midline
Laterally - anterior border of the sternocleidomastoid
Boundaries of the posterior triangle?
Anteriorly - posterior border of the SCM
Laterally - anterior border of the trapezius
Inferiorly - clavicle
Different positions of neck lumps and causes of each:
- Superficial lumps:
• Sebaceous cysts
• Lipomas
• Neurofibromas - Midline swellings:
• Thyroid (i.e: goitre)
• Thyroglossal cyst
• Dermoid cyst
3. Anterior triangle swellings: • Lymph nodes (most common) • Branchial cyst • Salivary glands • Carotid body tumour
- Posterior triangle swellings:
• Lymph nodes
• Cystic hygroma
Movements of a neck lump?
Does it move on swallowing? - if it does, the lump is in the thyroid
Does it move on sticking out tongue? - if it moves up with this, it is a thyroglossal cyst
Inspection of neck lumps?
Deformities
Abnormal movements
Skin changes: • Scars • Pigmentation • Rashes • Spider naevi • Swellings
Palpation of neck lumps?
Thyroid
Lymph nodes
Salivary glands
Features of neck lumps to consider?
Position, size and shape
Mobility, e.g: movement on swallowing or sticking out tongue
Consistency
Assoc. lymphadenopathy
Causes of cervical lymphadenopathy?
Infective cause
Malignancy cause
Haematological cause, e.g: leukaemia, lymphoma
History features with cervical lymphadenopathy?
Systemic symptoms:
• Fever
• Weight loss
• Sweats
Specific symptoms:
• Hoarseness
• Cough
• Dyspnoea
Background:
• Recent immigration
• Travel abroad
Other areas to check if cervical lymphadenopathy is palpated?
Palpate for other nodes, for primary sites and for hepatosplenomegaly
Ix if cervical lymphadenopathy is palpated?
CXR
ENT opinion
FNA (fine needle aspiration)
Pathways to follow with different patterns of cervical lymphadenopathy?
If only in neck, look for primary site and use ENT/CXR/biopsy
If generalised, consider the liver/spleen and use haematology/biopsy
If solitary, consider infective/malignancy causes and use biopsy
Presentation of thyroglossal cyst?
May arise in any parts of the thyroglossal tract and lymphatics can becomes involved; usually presents in teenage years
Lump moves with moving tongue
May occasionally fistulate (thyroglossal fistula); the hole tends to be anterior to the SCM and it leaks saliva
Dermoid cyst and its presentation?
Rare congenital cyst that usually present in teenage years
It is soft and non-fluctuant
Branchial cyst and presentation?
Persisting 2nd branchial arch; it arises in the upper part of the anterior triangle
Usually present in teenage years with a soft swelling that feels like a “half-filled hot water bottle)
May fistulate
