Neck lumps

Question 1

Features of the lump in lymphoma

• on examination
• associations (in history)

Answer 1

• Rubbery, painless lymphadenopathy
• The phenomenon of pain whilst drinking alcohol is very uncommon
• There may be associated night sweats and splenomegaly

Question 2

Features of the lump in the thyroid swelling

Answer 2

• May be hypo-, eu- or hyperthyroid symptomatically
• Moves upwards on swallowing

Question 3

Features of thyroglossal cyst

Answer 3

• 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

Question 4

Features of pharyngeal pouch

Answer 4

• 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

Question 5

Features of cystic hygoma

Answer 5

• a congenital lymphatic lesion (lymphangioma)
• typically found in the neck, classically on the left side
• Most are evident at birth, around 90% present before 2 years of age

Question 6

Features of branchial cyst

Answer 6

• oval, mobile cystic mass
• 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

Question 7

Features (on examination) of the carotid aneurysm

Answer 7

• Pulsatile lateral neck mass
• doesn’t move on swallowing