Neck Lumps

Question 1

What are the red flags for a malignant neck lump?

Answer 1

• hard and fixed lump
• otalgia, dysphagia, stridor, hoarse voice
• epistaxis or unilateral nasal congestion
• weight loss, fever, night sweats, rigors
• cranial nerve palsies
• in children, include: supraclavicular mass, lump > 2cm, history of malignancy

Question 2

What are the causes of a midline neck lump?

Answer 2

Thyroiditis
Thyroid nodules
Dermoid cyst
Thyroglossal cyst

Question 3

What are the inflammatory causes of a lateral neck lump?

Answer 3

Reactive lymphadenopathy
Infective lymphadenopathy –> HIV, TB
Submandibular sialadenitis
Parotitis

Question 4

What are the non inflammatory causes of a lateral neck lump?

Answer 4

Branchial cyst
Laryngocele
Parotid tumours
Schwannoma
Paraganglioma
Lipoma
Parapharyngeal space tumours

Question 5

What are the malignant causes of a neck lump?

Answer 5

Metastatic SCC
Primary parotid cancer
Metastatic thyroid cancer
Lymphomas

Question 6

What is the first line investigation for a neck lump?

Answer 6

USS + fine needle aspiration cytology

Question 7

What is a cystic hygroma?

Answer 7

Benign fluid filled sac caused by malformation of lymphatic system

Question 8

Where is a cystic hygroma usually found?

Answer 8

Posterior triangle of the neck or

Axilla

Question 9

At what age are cystic hygromas normally identified?

Answer 9

Usually before age 2

May be seen antenatally + treated in utero if risk of airway compromise at birth

Question 10

What are the clinical features of a cystic hygroma?

Answer 10

Soft, painless, fluctuating mass that transilluminates

Can grow large enough to cause dysphagia or obstruct the airway

Question 11

How is a cystic hygroma managed?

Answer 11

Only needs treatment if symptomatic:

• surgical excision or
• lymphatic sclerotherapy (injection of sclerosis agent into cyst)

Question 12

What is a carotid body tumour?

Answer 12

Benign, neuroendocrine tumour from paraganglion cells of carotid body (paraganglioma)

Question 13

What are the clinical features of a carotid body tumour?

Answer 13

Pulsatile, painless neck lump
Bruit on auscultation
Can move from side to side but not up and down (because in carotid sheath)
Slow growing but can compress cranial nerves –> palsies

Question 14

How is a carotid body tumour managed?

Answer 14

Conservative –> regular imaging

Surgical excision in specialist unit –> ENT + vascular

Question 15

What is a thyroglossal cyst and why does it occur?

Answer 15

Congenital, fluid-filled sac

Embryological failed closure of thyroglossal (thyroid –> tongue) duct

Question 16

What age do thyroglossal cysts usually present?

Answer 16

Under 20

Question 17

What are the features of a thyroglossal cyst?

Answer 17

Palpable, painless, midline mass
–> moves up when tongue protrudes
If infected –> painful + bigger

Question 18

What is the management for thyroglossal cysts?

Answer 18

Surgery –> Sistrunk procedure

- central body of hyoid bone removed to allow complete removal of thyroglossal tract

Question 19

Where do branchial cysts occur?

Answer 19

Lateral neck
Anterior to sternocleidomastoid
Unilateral

Question 20

Who gets branchial cysts?

Answer 20

Young adults

Question 21

What are the complications of branchial cysts?

Answer 21

Can become infection

If large –> dysphagia, dysphonia + breathing difficulties

Question 22

How is a branchial cyst managed?

Answer 22

Surgical excision