Neck Lumps Flashcards
List the structures in the neck that can become enlarged leading to the formation of neck lumps.
Arteries Nerves Lymphatics Lymph nodes Salivary glands Larynx Pharynx Branchial arch remnant Skin/superficial subcutaneous tissue Muscle/cartilage/bone
Describe the effect of age on the differential diagnosis of neck lumps.
Young – 75% of neck lumps are benign (usually congenital or inflammatory)
Over 40 yrs – 75% of neck lumps are malignant (80% of these are metastases)
NOTE: as a rule of thumb, in the absence of signs of infection, a lateral neck mass in an adult is lymphadenopathy due to metastatic carcinoma until proven otherwise
List some important questions to ask about the history of presenting complaint.
How long has the lump been there?
Has the lump got bigger, smaller or stayed the same size?
Is the lump painful?
Are there any other lumps?
Describe how the length of time the lump has been around for can help narrow the differential diagnosis.
< few weeks: infective or inflammatory (NOTE: malignant neck lumps may be noticed late)
More than a few weeks: must exclude malignancy
Years with little change: most likely to be benign
How does the size of the lump change in malignancy?
Very slow growing
Except for anaplastic tumours, which grow rapidly
Which types of neck lumps are painful?
Acute infective lymphadenitis
Infected branchial cyst
Why is it important to check for lumps in other parts of the body?
It may indicate systemic disease (e.g. HIV, EBV) or disseminated malignancy (e.g. lymphoma)
List some associated symptoms that are suggestive of infection as the cause of the neck lump.
Malaise
Fever
Rigors
What are the B symptoms of lymphoma?
Fever
Night sweats
Weight loss
List some associated symptoms that may suggest head and neck cancer.
Dysphonia Stridor Stertor Breathing difficulty Dysphagia Odynophagia Globus Cough Haemoptysis Otalgia
List some other features of the history that would suggest that infection is the more likely cause of the neck lump.
History of recent infection (particularly URTI)
Contact with someone who has an infectious disease
Recent trauma, insect bites or animal bites/scratches
List some other features of the history that would suggest that malignancy is the more likely cause of the neck lump.
Previous cancer Family history Previous radiotherapy to the neck Smoking Alcohol
List some types of superficial neck lumps.
Epidermal cyst
Dermoid cyst
Abscess
Lipoma
List some types of neck lump that occur in the anterior triangle.
Branchial cyst/sinus/fistula Carotid body tumour Carotid artery aneurysm Salivary gland pathology Laryngocoele Lymphadenopathy
List some types of neck lump that occur in the posterior triangle.
Cervical rib Lymphatic malformation Pharyngeal pouch Subclavian aneurysm Lymphadenopathy
Describe how the relationship of the lump to surrounding muscles can be tested.
Get the patient to tense the sternocleidomastoid and the trapezius
If the lump is underneath the muscle, it will be concealed when the muscle contracts
Which types of lumps tend to be tender and warm?
Infected or inflammatory lumps
List the diseases that are associated with the following types of neck lumps: Hard Rubbery Soft Fluctuant
Hard Malignant lymph nodes Rubbery Chronic inflammatory lymph nodes (e.g. tuberculosis) Soft Acute inflammatory lymph nodes Fluctuant Branchial cyst Pharyngeal pouch Laryngocoele Epidermal cyst Dermoid cyst
Which types of neck lump may be pulsatile?
Subclavian and carotid artery aneurysms
Carotid body tumours
Describe how the mobility of the neck lumps can give clues about the type of neck lump.
Most lymph nodes are relatively mobile
Malignant lymph nodes appear tethered to surrounding structures
What else should you examine if infectious lymphadenopathy is suspected?
Throat (mainly tonsils)
All lymph nodes in the head and neck
What else should you examine if malignant lymphadenopathy is suspected?
Scalp, face, ears, mouth and nose for potential SCC and malignant melanoma
Otalgia in the absence of anything abnormal on otoscopy suggests malignancy (referred pain to ear)
All lymph nodes in head and neck
Breasts and lungs
Palpate for hepatosplenomegaly (if lymphoma or CLL suspected)
Abdominal examination if Virchow’s node is enlarged
Why is it important to examine the facial nerve if the patient has a parotid swelling?
The facial nerve sits between the superficial and deep lobes of the parotid gland and a malignant tumour of the parotid may cause facial nerve palsy
What method is used to diagnose the cause of lymphadenopathy?
Fine needle aspiration
