Neck Lumps

Question 1

Borders of the anterior triangle of the neck?

Answer 1

Median line of the neck (medial border)

Anterior border of the SCM (lateral border)

Inferior border of the mandible (superior border)

Question 2

Borders of the posterior triangle of the neck?

Answer 2

Posterior border of the SCM (anterior border)

Anterior border of the trapezius (posterior border)

Middle 1/3rd of the clavicle (inferior border)

Question 3

Infectious signs and differentials with neck lumps?

Answer 3

Lymphadenopathy, fever, fatigue

- glandular fever, HIV

Question 4

Malignant signs and differentials with neck lumps?

Answer 4

Lymphadenopathy, night sweats, pain, weight loss, fatigue, growing lump

• thyroid cancer
• salivary gland cancer

Question 5

Endocrine differentials of neck lump?

Answer 5

Hyper/hypothyroidism goitre

Question 6

Dermatological differentials of neck lump?

Answer 6

Sebaceous cyst (from blocked sebaceous glands/hair follicles)
Lipoma (benign tumour of fat tissue)

Question 7

Vascular differentials of neck lump?

Answer 7

Carotid body aneurysm

Question 8

Congenital/developmental differentials of neck lump?

Answer 8

Thyroglossal cyst (persistent thyroglossal duct)
Branchial cyst

Question 9

Lateral neck lumps malignancy potential in

Answer 9

Children >75% lateral neck lumps are benign

Adults >75% lateral neck lumps are malignant

Question 10

Lateral neck lump differentials?

Answer 10

Carotid/subclavian artery aneurysm
Lymphadenopathy
Salivary gland cancer
Branchial cyst
Lipoma/epidermal cyst/dermoid cyst
- assess lump with SCTF

Question 11

Midline neck lump differentials?

Answer 11

Thyroid

• physiological goitre
• multinodular goitre
• Graves’
• Hashimoto’s thyroiditis (hypothyroidism!)
• thyroglossal cyst
• solitary adenoma
• carcinoma
• De Quervain’s thyroiditis

Non-thyroid

• lipoma
• dermoid/epidermal cyst
• abscess
• lymphoma

Question 12

Principle differences and similarities between differentials for lateral and midline neck lumps?

Answer 12

Skin lumps are present in both cases (lipoma, dermoid/epidermal cysts, abscesses etc)

Lateral is more focused on enlargement local structures (lymphadenopathy, aneurysms) while midline has a significant number of thyroid-related lumps

Question 13

Key features of neck lumps for diagnosis?

Answer 13

Deep lump = thyroid
Superficial = lipoma, epidermal/dermoid cyst, abscess

Moves on swallowing = thyroid gland
Moves on tongue protrusion = thyroglossal cyst