Neck Lumps Flashcards
What questions should you ask when assessing a neck lump?
How long has the lump been present?
If < 3 weeks reactive lymphadenopathy from a self-limiting infection is likely
Which tissue layer is the lump in?
Intradermal: sebaceous cyst with central punctum, lipoma
SSS CCC TTT Site size Surface Colour Contour Consistency Tenderness Temperature Transilluminable
Fluctuance
Fixed
Fields
Pulsatile Expansile Reducible
What investigations in neck lumps?
US CT Mantoux CXR Fine needle aspiration cytology
What is likely in a midline lump in a <20 year old?
Dermoid cyst
What is likely if the midline lump moves up on protruding the tongue and is below the hyoid? What is this?
Thyroglossal cyst - fluid filled sac resulting from incomplete closure of the thyroid’s migration path
Surgery
What is likely if midline lump > 20 years old
What is if it bony hard?
Thyroid mass - moves upward on swallowing
Chondroma - benign cartilaginous tumour
What are the borders of the submandibular triangle?
Above - mandible Below - digastric
What is likely if submandibular triangle lump < 20 years?
Reactive lymphadenopathy
What should you check if submandibular triangle lump > 20 years? How would you determine this?
Malignant lymphadenopathy Firm and non-tender Fever Night sweats Weight loss
TB?
What is likely if submandibular triangle lump if it is not a node?
Submandibular salivary stone
Tumour
Sialadenitis - inflammation of salivary glands
What are the borders of the anterior triangle?
Between midline, anterior border of sternocleidomastoid and the line between the two angles of the mandible
What are branchial cysts? Where do they occur? Investigation? Mx?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Usually unilateral
Emerge under anterior border of sternocleidomastoid where the upper 1/3 meets the middle 1/3
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Investigation: FNAC - acellular fluid with cholesterol crystals
Treat by excision
What is a lump in the superoposteriar are of the anterior triangle
Parotid tumour
How do laryngocoeles present?
Painless
Males
Made worse by blowing
What can an anterior triangle pulsatile lump be?
Carotid artery aneurysm
Tortuous carotid artery
Carotid body tumour (chemodectoma)
Describe a carotid body tumour
Move from side to side but not up and down and splay out the carotid bifurcation.
Firm and pulsatile
Suspact andy mass just anterior to the upper 1/3 of sternocleidomastoid
Do MRA
What are the borders of the posterior triangle?
Behing sterncleidomastoid
Infront of trapezium
Above clavicle
What lumps can occur in the posterior triangle?
Cervical ribs may intrude into this area
Can cause neurological symptoms by compressing brachial plexus or Raynaud’s by compressing the subclavian artery
Pharyngeal pouches can protrude into posterior triangle on swallowing
Cystic hygromas
- congenital lymphatic lesion classically on the left side
Lymphadenopathy if many small lumps
- TB, viruses, HIV, EBV
- Lymphoma - B symptoms?
- Metastases
What would you see in lymphoma?
Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly
What would you see in a thyroid swelling?
Moves upwards on swallowing
What would you see in thyroglossal cyst?
More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
What are features of pharyngeal pouch?
More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
What are features of branchial cyst?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
What are features of carotid aneurysm?
Pulsatile lateral neck mass which doesn’t move on swallowing
What are complications of thyroid surgery?
Anatomical such as recurrent laryngeal nerve damage.
Bleeding. Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.
Damage to the parathyroid glands resulting in hypocalcaemia.
