Neck lumps Flashcards
Name the boundaries of the anterior triangle in the neck
Mandible superiorly
Anterior border of the sternocleidomastoid laterally
Midline medially.
Name the boundaries of the posterior triangle
Posterior border of the sternocleidomastoid anteriorly
Anterior border of the trapezius laterally.
Clavicle inferiorly
Why does your thyroid move when you swallow?
Because it is enveloped in pretracheal fascia.
Swellings in the anterior triangle could be?
Lymph nodes
Branchial cyst
Salivary glands
Carotid body tumor
Swellings in the posterior triangle could be?
Lymph nodes
Cystic hygroma
What would you look for in a neck lump?
Position Movement Size Shape Consistency
Most common cause of neck lumps
Lymph nodes
Cervical lymphadenopathy
Enlargement of the cervical lymph nodes
Causes of cervical lymphadenopathy
Infective
Malignant
Haematological- leukaemia/lymphoma.
What should you do if cervical lymphadenopathy is present?
Look for other nodes
Look for primary sites
Look for hepatosplenomegaly.
Where do thyroglossal cysts occur?
In the thyroglossal tract (the path of embryological development of the thyroid gland)
However usually above the hyoid bone.
What may become infected in a thyroglossal cyst?
Lymphatics within the thyroglossal duct.
On examination- what movement will show a thyroglossal cyst?
It will move with the tongue.
Who will a thyroglossal cyst likely affect?
Teenagers.
Complications associated with thyroglossal cysts?
Sometimes they can fistulate (abnormal connection between two epithelial surfaces) out of the neck.
If big- may cause local effects.
Where would you find a dermoid cyst?
Presents as a midline swelling
What are dermoid cysts?
Rare congenital cysts.
Who do dermoid cysts usually present in?
Teenagers.
What is the 2nd most common cause of anterior triangle swellings?
Branchial cysts
Site of presentation of branchial cysts
Usually present in the upper part of the anterior triangle.
Consistency of branchial cysts
Feels like a half filled hot water bottle.
What is a cystic hygroma
Lymphatic sac occurs in the posterior neck resulting in a lymphatic fluid accumulation.
Transilluminates and can press on local structures.
Where else can cystic hygromas effect?
The axilla.
What age group do cystic hygromas normally affect?
Usually young children- present normally in the first year.
Why should you examine the mouth in neck swellings?
The cause of the swelling may be a tumour of the salivary glands.
Which salivary gland are you most likely to get a stone in and why?
Submandibular gland due to it being mucin secreting.
Patient is hoarse- likely to be
Thyroid carcinoma with invasion of the recurrent pharyngeal nerve.
Lump in neck that moves up and down and lump in anterior triangle that doesnt move.
Likely to be papillary cancer with lymph node involvement.
Investigations into lumps?
Fine needle aspiration.
Th1 result on FNA
inadequate
Th2 result on FNA
Benign
Th3 result on FNA
Suspicious (25% malignant)
Th4 and Th5 result on FNA
Malignant.
If you have got back Th1 or Th2 result on FNA, what do you do?
Repeat FNA.
If you have got back Th3 result on FNA, what do you do?
Thyroid lobectomy
If you have a Th4 or Th5 result on FNA, what do you do?
Total thyroidectomy
