Neck lumps Flashcards
Lumps that can appear anywhere (2)
lipomas
sebacious cysts
Features of lipomas (4)
soft, fluctuant lump
skin can be “pinched off” it
benign
often present for many yrs
Features of and epidemiology of sebacious cysts (6)
hard lump w. smooth surface
punctum
mobile
within skin
non-tender
more commonly affects males
Causes of midline masses (6)
if <20yrs:
- dermoid cyst
- thyroglossal cyst
if>20 yrs:
- thyroid mass
- chondroma
- pharyngeal pouch
- laryngocele
Features of dermoid cysts (2)
teratoma (mature)
large, hard midline lump
Pathology, features and Ix of thyroglossal cysts (4)
due to thyroglossal duct which pulls thyroid down from tongue remaining patent>cyst formation
move on protrusion of tongue
transilluminates
in children do radioiodine uptake scan to ensure they have functioning thyroid.
Features and subtypes of thyroid masses (5)
move up on swallowing,
not on tongue protrusion
papilloma
anaplastic
follicular
medullary
Features of thyroid papilloma (4)
most common
20-55yrs
often multifocal
cells have finger-like projections, ground glass nuclei and psammoma bodies
Features and presentation of anaplastic thyroid ca. (6)
most dangerous
rare
> 65yrs
hard, irregular lump
locally invasive
presents w. sudden onset wt. loss and hoarse voice w. surrounding lymphadenopathy.
Features of follicular thyroid ca.
can’t Dx w. FNA
Features of medullary thyroid ca. (2)
(C cell)
assoc. w. MEN2a
presents w. diarrhoea
assoc. w. CEA
Features of chondromas (2)
hard, bony lump
benign cartilaginous tumour
Features of pharyngeal pouches (2)
halitosis (bad breath)
gurgles on palpation
Pathology and features of laryngoceles (3)
outpouching of larynx from pressure
smooth, reducible lump
causes discomfort
(think trombone players)
Causes of neck lumps in submandibular triangle (6)
benign lymphadenopathy-most common cause
malignant lymphadenopathy
submandibular salivary stone
tumour
sialadenitis
cervical rib
Causes of benign submandibular lymphadenopathy (5)
TV
viruses: EBV, CMV HIV
bartonella (cat scratch)
toxoplasmosis
lymphoma
Features of malignant submandibular lymphadenopathy (2)
firm
non-tender
Features of submandibular salivary stones (3)
calculus in submandibular salivary gland
dull pain and swelling
intense pain may occur after eating
Features of sialadenitis
inflamed salivary gland
Causes of anterior triangle lumps (3)
branchial cysts
carotid body paraganlgiomas
carotid artery aneurysms
Pathology and features of branchial cysts (4)
due to failure of obliteration of 2nd branchial cleft in embryological development
oval, fluctuant, cystic, non-tender mass
between pharynx and sternocleidomastoid
can become infected>fistula
Epidemiology and common presentation of branchial cysts (2)
M>F
often present w. URTI
Ix and Rx of branchial cysts
aspiration>cholesterol crystals
Rx w. sclerotherapy or surgery, aspiration not sufficient
Features of carotid body paraganliomas (5)
tumour of carotid body
hard
pulsatile w. no bruit
move horizontally but not vertically
more common at high altitude
Features of carotid artery aneurysms (4)
pulsatile
bruit
soft and fluctuant
w/i anterior triangle
Ix for carotid artery aneurysms (2)
digital subtraction angiography 1st line
can also do doppler US
Causes of posterior triangle masses (5)
LNs
lymphoma
cystic hygroma
sternocleidomastoid tumour of infancy
cervical rib
Features and Rx of cystic hygromas (5)
soft lump
transilluminates brightly
multiple cyst-like cavities containing lymph
common in babies/neonates
can be drained/Mx w. sclerosing agents
Features and Rx of sternocleidomastoid tumours of infancy (5)
presents between 2wks-3mo
palpable, hard, mobile and painless
felt in lower middle third of sternocleidomastoid
assoc. w. congenital torticollis
benign, Rx w. physio and stretching.
Sx of cervical ribs (2)
due to compression-thoracic outlet syndrome:
- wasting of intrinsic hand muscles (brachial plexus)
- Raynaud’s (subclavian artery)
Ix for neck lumps (6)
US for consistency but can’t Dx
biopsy is gold standard: FNAC/core biopsy
CT to show exact location
virology: HPV, EBV
Mantoux for TB
CXR for TB/sarcoid.
