Neck Lumps

Question 1

Reactive lymphadenopathy

Answer 1

By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness

Question 2

Lymphoma

Answer 2

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

Question 3

Thyroid swelling

Answer 3

May be hypo-, eu- or hyperthyroid symptomatically

Moves upwards on swallowing

Question 4

Thyroglossal cyst

Answer 4

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 5

Pharyngeal pouch

Answer 5

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 6

Cystic hygroma

Answer 6

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
Posterior triangle of neck
Collection of dilated lymphatic sacs which are fluctuant and brilliantly transilluminable
Recurrence following surgical excision is not uncommon.

Question 7

Branchial cyst

Answer 7

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

Question 8

Cervical rib

Answer 8

More common in adult females

Around 10% develop thoracic outlet syndrome

Question 9

Carotid aneurysm

Answer 9

Pulsatile lateral neck mass which doesn’t move on swallowing