Neck Lumps

Question 1

Parapharyngeal abscess

Answer 1

• Neck mass
• Unwell
• Febrile
• Decreased rotational neck movements

Question 2

Retropharyngeal abscess

Answer 2

• Swinging pyrexia (picket fence)
• Decreasedneck movements
• May be relatively well
• Usually children
• May cause airway compromise

Question 3

Differential diagnosis of neck lumps

Answer 3

Question 4

Reactive lymphadenopathy

Answer 4

• Most common cause of neck swellings
• May be history of local infection or generalised viral illness

Question 5

Lymphoma

Answer 5

• Rubbery mass, painless lymphadenopathy
• Pain whilst drinking alcohol is very uncommon
• May be associated night sweats and splenomegaly

Question 6

Thyroid swelling

Answer 6

• May be hypothyroid or hyerpthyroid symptomatically
• Moves upwards on swallowing

Question 7

Thyroglossal cyst

Answer 7

• More common in patients <20 years
• Usually midline, between the isthmus of the thyroid and the hyoid bone
• Moves upwards with protrusion of the tongue
• May be painful if infected
• Duct cysts are failure of the thyroglossal duct to obliterate during development
• Malignant transformation can occur later in life
• Red flags include:
  
  • FHx of thyroid carcinoma
  • Radiation Hx
  • Child
  • Hoarseness
  • Associated cervical lymphadenopathy
  • Associated pain

Question 8

Pharyngeal pouch

Answer 8

• 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
• Management:
  
  • Alter diet and risk factors
  • Reflux control
  • Endoscopic revision/stapling or open resection

Question 9

Cystic hygroma

Answer 9

• Congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
• Most are evident at birth

Question 10

Branchial cyst

Answer 10

• Oval, moblie 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
• Uncommon in >35 years so must exclude cystic metastasis

Question 11

Cervical rib

Answer 11

• More common in adult females
• Around 10% develop thoracic outlet syndrome

Question 12

Carotid aneurysm

Answer 12

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

Question 13

Epidermoid cysts

Answer 13

• Common cutaneous cysts that result from the proliferation of epidermal cells within a circumscribed space of the dermis
• Usually asymptomatic
• Firm, round nodules of various sizes

Question 14

Parotid lump

Answer 14

• Majority of salivary gland lumps are parotid
• 80% benign
  
  • Pleomorphic adenoma
  • Warthins (can be bilateral)
• Malignancy
  
  • Pain
  • Facial nerve palsy (nerve runs through parotid)
  • Skin changes
  • Associated lymphadenopathy
  • May have intraoral component
• Require US + FNA
• If malignant can be treated by parotidectomy

Question 15

Causes of globus sensation (feeling of something stuck in throat with no pathological findings)

Answer 15

• Increased tension in the muscles of the neck/pharynx
• Stress and anxiety
• Acid reflux