Neck Lumps Flashcards
What investigations can you do for neck lumps?
Virology and TB tests
CXR may show malignancy or lymphadenopathy
USS shows consistency of the lump
Fine Needle Aspiration should be considered
What is the likely diagnosis of a midline neck lump if the patient is;
1) <20 years old
2) The lump moves upwards with tongue protrusion and is below the hyoid
3) >20 years old
4) Bony hard lump
1) Dermoid cyst
2) Thyroglossal cyst
3) Thyroid isthmus mass
4) Chondroma (benign cartilaginous tumour)
If a lump is found in the submandibular triangle, what is the most likely diagnosis if…
1) The patient is <20 years
2) The patient is >20 years
3) If the lump is not a node
1) Self limiting lymphadenopathy
2) You need to exclude malignant lymphadenopathy
3) Salivary stone, tumour, sialadenitis
If a lump presents in a patient <20 years in the anterior triangle, anterior to the border of the sternocleidomastoid, where the superior third meets the middle third, what is the most likely diagnosis?
Branchial cysts
Branchial cysts are lined by squamous epithelium and their fluid contains cholesterol crystals
They are congenital remnants from embryo logical development
Treat by excision
If a patient >40 years presents with a lump in the supero-posterior area of the anterior triangle, what diagnosis do you need to think about?
Parotid tumour
What are the causes of neck lumps in the posterior triangle?
Pharyngeal pouches (protrude during swallowing) Cystic hygromas (in infants, transilluminate) Pancoasts tumour
What is a typical history that a patient will give who has a salivary gland pathology?
What are the investigations for a salivary gland pathology?
Lumps
Swelling and pain related to food
If it is a salivary stone: recurrent unilateral pain and swelling will be seen. 80% are submandibular
Look for external swellings, lymph nodes, do bimanual palpation for stones, examine VIIIth nerve, do FNA
What could the diagnoses be for a patient with a fixed salivary gland swelling?
Tumour
ALL
Granulomatosis with polyangiitis
What is the most common salivary gland tumour?
Parotid tumour which is a pleomorphic adenoma in the superficial lobe
Deflection of the ear outwards is a classic sign
What is the most common benign salivary gland tumour and how do you treat it?
Pleomorphic Adenoma is the most common
Remove by superficial parotidectomy
What features suggest malignancy of a salivary gland lump?
VIIIth nerve palsy Dysphagia Voice change Pain Difficulty swallowing
What is the difference between a diffuse goitre and a nodular goitre?
Diffuse: when the entire thyroid swells
Nodular: when there is a lump that develops on the thyroid
What are the causes of a diffuse goitre?
Iodine deficiency
De Quervains thyroiditis
Pregnancy or puberty
Graves or Hashimotos
What are the causes of a nodular goitre?
Multinodular goitre (most common) Fibrotic goitre: Riedels thyroiditis Solitary thyroid nodule: usually a cyst or Adenoma
What are the investigations of a thyroid lump?
TSH and USS
If these are abnormal, consider T4 autoantibodies
CXR with thoracic inlet view
Radionuclide scans (for hot or cold)
FNA
