Neck Lumps Flashcards
What are most neck lumps caused by?
A benign cause
Why is thorough assessment of neck lumps necessary?
Because it could be due to more serious disease
What is the most common cause of neck lumps?
Reactive lymph nodes
What are the most common causes of reactive lymph nodes?
- Bacterial
- Viral
- Parasitic
- Non-infective causes
What are the common bacterial causes of reactive neck lymph nodes?
- Beta haemolytic strep
- Staph aureus
- Tuberculosis
- Secondary syphilis
What are the common viral causes of reactive neck lymph nodes?
- URTI viruses
- EBV
- CMV
- HIV
- HSV
What are the common parasitic causes of neck reactive lymph nodes?
- Head lice
- Fungal infections
- Toxoplasmosis
What are the common non-infective causes of reactive neck lymph nodes?
- Sarcoidosis
- Connective tissue disease
What are some rare types of neck lumps?
- Malignant lymph nodes
- Infections of the skin
- Lipomas and other benign tumours
- Thyroid swellings
- Salivary gland problems
- Congenital swellings
- Developmental abnormalities
- Carotid aneurysm or tumour
- Malignant tumours
What can cause malignant cervical lymph nodes?
- Leukaemia
- Lymphoma
- Metastases
What infections of the skin can cause neck lumps?
- Abscess
- Infected sebaceous cyst
What benign tumours can cause neck lumps?
- Lipomas
- Fibromas
- Chondromas
- Neuromas
- Vascular tumours
What types of thyroid swellings can cause neck lumps?
- Diffuse enlargement
- Nodules
- Cancers
What salivary gland problems can cause neck lumps?
- Tumours
- Blocked ducts
- Infection and inflammation
What congenital swellings can cause neck lumps?
- Thyroglossal cyst
- Dermoid cyst
- Cystic hygrometer
- Lymphangioma
What developmental problems can cause neck lumps?
- Branchial cyst
- Laryngocoele
- Pharyngeal pouch
- Cervical rib
What malignant tumours can cause neck lumps?
- Sarcoma
- Chondrosarcoma
- Skin malignancy
What factors should be considered when assessing history of a neck lump?
- Age of patient
- Onset
- Consistency and mobility
- Location
- Associated symptoms
What type of neck lumps are more common in young people?
Inflammatory (more common than malignant)
What types of neck lumps are common in children and young people?
Congenital and developmental causes
What is the typical natural history of inflammatory neck lumps?
- Sudden onset
- Resolution in 2-6 weeks
What does progressive enlargement over short period of time suggest of a neck lump?
More likely to be malignant
What features of history suggest salivary gland problem as a cause of neck lump?
Transient with association with eating
What is a hard neck lump more likely to be?
Malignancy
How do congenital masses usually feel?
Smooth and mobile
How can thyroid gland swellings and thyroglossal cysts be identified on examination?
They move when swallowing (thyroglossal cysts move when tongue moved out)
What does a tender neck lump suggest?
Infection
What are midline lumps more likely to be?
Thyroid in origin
What a posterior triangle lumps most commonly?
Lymph nodes
What are bilateral swellings across the mandibular angles likely to be?
Parotid infection
What can submandibular swellings be related to?
The submandibular gland
What can a lump in the left supraclavicular ross indicate?
Infraclavicular metastatic malignancy
What are some red flag symptoms of haematological malignancies?
- Night sweats
- Weight loss
- Pruritis
- Fever
- Bruising
- Breathlessness
- Fatigue
What investigations can be used to differentiate neck lumps?
- FBC and ESR
- TFT
- Viral serology
- Throat swab
- CXR
- USS
- Radionucleotide scanning
- CT or MRI
Where should neck lumps be referred?
ENT but also dermatology, oral surgeon or chest physician depending on suspected cause
When should an urgent 2WW referral be made for patients with a neck lump?
- Lost weight
- Hoarseness, dysphagia or dyspnoea for >3 weeks
- Symptoms of haematological malignancy
- Unexplained large lymph node
- Suspicious clinical features
- Diagnosis unclear
