Neck Lumps

Question 1

Common causes of neck lumps

Question 2

Differentiate neck masses in children vs adults

(rule of 80’s)

Answer 2

Children> 90% mainly benign

Adults

• 80% of non thyroid neck masses r NEOPLASTIC
• 80% of them r MALIGNANT

Question 3

What diagnostic tests can you do? What is the 1st line?

Answer 3

Full blood count and erythrocyte sedimentation rate (ESR).
• Viral serology: Epstein–Barr virus, cytomegalovirus and toxoplas-
mosis.
• Throat swab: occasionally helpful, but must be sent immediately
in the proper medium.
• Thyroid function tests and ultrasound in all cases of thyroid en-
largement.
• Chest X-ray in smokers with persistent neck lump.
• Fine needle aspiration biopsy (FNAB) is helpful for the diagnosis of
neck masses and any neck lump that is not an obvious abscess and
persists following antibiotic therapy. A negative result may require a
repeat FNAB, ultrasound-guided FNAB or even an open biopsy.
• Ultrasonography is useful in differentiating solid from cystic mass-
es. 1ST LINEEEE

Question 4

Differentials for midline & lateral lumps?

Question 5

Name this defect and describe characteristics? Outcome?

Answer 5

Lymphangioma

soft doughy, ill-defined

usually remains unchanged into adulthood

Question 6

Name this defect and describe characteristics? Outcome?

Answer 6

Hemiangioma

bluish and compressible

most often RESOLVES SPONTANEOUSLY w/in 1st decade

Question 7

What r 2 non malignant congenital neck lumps/ lesions that r can arise w/ in the 1st year of life?

Answer 7

Hemiangioma and lymphangioma

Question 8

Name this defect and describe characteristics? Outcome?

Answer 8

common masses occurring most often in older people but can occur at any age.

slow growing, but sometimes flnuctuant and painful when infected.

Diagnosis is made clinically >> the skin overlying the mass is adherent and a punctum is often identified.

Question 9

Name this defect and describe characteristics? Outcome?

Answer 9

Smooth, flunctant mass underlying the anterior border of the sternocleidomastoid

usually appears rapidly after an upper respiratory tract infection as a tender mass

treat with antibiotics & surgical excision

Question 10

Answer 10

Thyroglossal cyst

Common congenital MIDLINE mass , that can somtimes be pushed to the lateral border of the thyroid cartilage

Question 11

Treatment of thyroglossal duct cyst?

Answer 11

initial control of infection with antibiotics, followed by surgical excision including the mid-portion of the body of the hyoid bone

_“_Sistrunk procedure”

Question 12

Someone presents w/ tender swelling, odynophagia, trismus and occasional torticollis with systemic signs of infection?

how do u manage it? What is it

Answer 12

Question 13

What is the rule of thumbs?

Answer 13

is if a neck mass in an infant or child is bigger than a ‘golf ball’ after 3–4 weeks of observation or a course of antibiotics, then a serious underlying disease needs to be excluded – lymphoma or sarcoma.

Question 14

In Granulomatous lymphadenitis, what r the 2 most common causes of it in children?

Answer 14

atypical mycobacteria & cat scratch disease

Question 15

Different Btw cat scratch disease and atypical mycobacteria lymph swelling

(location and treatment)

Answer 15

Question 16

What is the most common benign soft tissue neoplasm in the neck?

Answer 16

LIPOMA

poorly defined soft masses, soft to the touch

surgical removal if it is increasing in size

Question 17

Answer 17

Salivary tumor

Question 18

When do u suspect a salivary tumor? R they mostly maliganant or benign?

how would u know?

Answer 18

Any enlarging mass at a radius of 5 cm from the angle of the mandible should raise suspicion for a primary parotid gland neoplasm

80% of which are benign.

Benign tumours are usually slow growing and asymptomatic

Rapid growth, facial nerve palsy, cervical adenopathy, skin fixation or pain suggests malignant disease.

Question 19

For a definite diagnosis of a salivary gland tumor, what can we do?

Answer 19

open excisional biopsy, either parotidectomy or submandibular gland excision, may be necessary.

Question 20

Question 21

Answer 21

Paraganglioma

Question 22

In the primary care setting, what r neck lumps mostly caused by?

what is the usual approaches?

Answer 22

inflammatory conditions that are self-limiting, resolving within 2–6 weeks.

A course of antibiotics with a 2-week follow-up assessment

if not resolve>> hospital referrel

immediate referall for high risk patiemts (smoking, chewing tobacco,alchohol)