neck lumps Flashcards
Thyroglossal cyst
congenital
a connection between the tongue and thyroid gland causing a midline mass.
smooth, non-tender
the midline of the neck, below the cricoid cartilage. forarmen cecum (tongue) defends down to form the thyroid (connection between tongue and thyroid that shouldn’t be there)
rises / moves upwards when patient protrudes the tongue or swallows
*thyroglossal duct connects the tongue to the thyroid gland
7% of the population, most commonly presents in childhood.
<20 y/o
palpable, painless, mobile and midline
moves up with tongue potrusion
can be painful if infected
referral to ENT
Sistrunk procedure
surgical removal if causing difficulty breathing/swallowing/recurrent infection
lipoma
benign soft tissue tumour in the neck
asymptomatic
soft, poorly defined masses deep to the skin
cystic hygroma
posterior triangle of the neck bordered by the SCM, trapezius and the clavicle
congenital
cystic (sometimes translucent) lymphatic lesion
occurs in the posterior triangle of the neck
occurs in 1% of children
no particular gender or ethnic preponderance. (birth/before 2 years old)
can be seen on antenatal ultrasounds in pregnancy
found in neck / axillae
soft painless swelling
sclerotherapy or surgical removal
branchial cyst
congenital epithelial cyst
lateral (anterior border, SCM) from the midline
failure of the obliteration of the second branchial cleft in embryonic development
painless and slow growing smooth fluctuant lateral neck (SCM) unilateral can increase in size and painful if infected does not transiulluminate does not move when swallowing
young adult
referral to ENT, abx if abscess or infection, excision
USS FNA to exclude cancer
aspirate- cholesterol crystals
surgically remove
become more apparent when infected e.g. following an URTI
ranula
mucocele in the floor of the mouth originating form the sublingual glands
clear / bluish cyst
floor of the mouth (mylohyoid)
- blocked duct causes swelling
- ruptured cyst leading to extravasation of mucin
acquired benign neck mass
childhood / early adulthood
tx: surgical excision
laryngocele
acquired benign neck mass
rare
the air-filled cyst can bulge internally into the larynx or externally into the neck (or both if the connection is between the thyrohyoid membrane)
intermittent neck swelling
palpable when Valsalva is performed
wind instrument players/glassblowers
air pocket arising from the deepest point of the laryngeal ventricle
tx: surgical excision (endoscopic or external approach)
pharyngeal pouch
acquired benign neck mass
pharyngeal pouch
acquired benign neck mass
palpable lump in the neck that can appear with meals or on examination
more common in older men
dysphagia can occur
regurgitation
halitosis
gurgling
neck lumps which are actually part of the normal anatomy
transverse process of c1 vertebra
hyoid bone
thyroid / cricoid cartilage
investigations for neck lumps
bloods (FBC, U+E’s, CRP)
plain neck radiograph
ultrasound scan imaging
- thyroid lump/swelling= nodular or diffuse
- inflammatory/lymphadenopathy
- malignat lesion
- normal anatomical structures
management of neck lumps
if symptoms of stridor or SVC obsturction admit immediately
consider admission if dysphagia, aspiration or signs of sepsis
urgent referral for suspected cancer
unexplaiend neck lump in >45 y/o
persistent and unexplained neck lump <45 y/o
referral for ultrasound
unexplained lump increasing in size
> 25 y/o 2 weeks
suspected cancer pathway if US findings uncertain or suggestive of soft tissue sarcoma
urgent ultrasound appointment (48hrs) for children and young peple
acute parotitis
painful pre-auricular swelling
globus pharyngeus
a sensation of a lump at the back of the throat, painless.
anxiety, pharyngeal spasm, reflux, hiatus hernia
eosinophilic oesophagitis
allergic reation with proliferation of eosinophils in the oesophagus
vomiting, loss of appetitie
achalsia
muscular layer of the oesophagus is affected
failure of relaxationof the lower oesophageal sphincter (LOS)
food bolus passsae is impaired
regurgitation
barium swallow- bird beak’s apperance
manometry (measures pressure) to confirm there is hypercontraction
laryngeal squamous cell carcinoma
associated with smoking (carcinogens)
hoarse voice, cough, difficult swallow
systemic signs
oesophageal ring
benign stricture at the lower end of the oesophagus
regurgitation
sebaceous cyst
smooth lumps caused by blockage of a hair follcile central punctum horn may develop on the top of the cyst attached to the skin mobile above deep structures
can become infection - tender, erythematous, hot
tx: excision to perform with a local anaesthetic
thyroid carcinoma
mass moves upon swallowing
hard, firm, non-tender
attached to the skin
close to the midline
thyroid goitre
moves up with swallowing
attached to the skin, close to the midline
smooth enlargement or multinodular
associated symptoms of thyroid disease
sternocleidomastoid tumor
congenital lump
first few weeks of life
grow and recede
typically restricts contralateral head movement
lipoma
deep to skin (skin moves frely)
soft, doughy, mobile on palpation
USS to rule out sarcoma or liposarcoma
cervical rib
extra rib that arises from 7th cervical vertebra and located above 1st rib
epidermoid cyst
contains unpleasant, white, thick foul smelling matter.
lipoma
deeper and firmer (than epidermoid cyst). can be indistinguishable when small
excise if symptomatic
infantile haemangioma
benign lesion caused by abnormal vessel growth in the skin an deeper structures.
results from proliferation oft he endothelial cells
usually first appears shortly after birth and peaks in 4th-6th week of life
tx: usually regress spontaenosly. oral beta blocker, propranolol.
take medical photography and review.
neck lump differentials (in summary)
infective
- reactive lymphadenopathy
- sialdenitis
neoplastic
- lymphoma
- head and neck tumor
- salivary gland tumour
- skin lump (lipoma benign) malignant (skin cancer)
vascular
- carotid body tumor
inflammatory
- sarcoidosis
traumatic
- haematoma
autoimmune
- graves (thyroid)
congenital
- cystic hygroma (posterior)
- thyroglossal cyst (midline)
- branchial cyst (lateral)
- dermoid cyst
cystic hygroma
a benign fluid filled sac caused by malformation oft the lymphatic system
<2 years old
can be seen on USS in pregnancy
posterior triangle of neck
soft, painless and fluctuant (transiominants)
only management if symptomatic (difficulty with breathing and feeding)
surgical excision
siladenitis
salivary glands submandibular and parotid viral / baccterial autoimmune (sjogrens) obstruction (siolith) malignancy
acute, rapid pain and swelling
can be chronic, intermittent and recurrent
fever, pain, dysphagia, swelling, erythema
purulent discharge
investigate:
clinical diagnosis
bedside: swabs,
bloods: FBC, CRP, ESR, autoimmmuen screening, blood cultures, viral serology (mumps)
special:
FNA
USS
management:
hydration
anaglesia
antibiotics (bacterial)
carotid body tumor
bengin neuroendocrine tumor
paraganglion cells of the carotid body. arises from carotid bifurcation.
sporadic but can be hereditary
painless pulsatile neck lump anterior to SCM. slow growing. doesn’t have a bruit on auscultation. can be moved side to side but not ups dn down.
can compress nearby structures and cause palsies (glossopharyngeal, vague, accessory, hypogloccssal)
imaging: doppler, aniography
conservative: monitor
surgical: ENT and vascular
raditopehapy
thyroid nodules
- simple goitre (TFT normal)
- toxic goitre (TFT abnormal)
- retrosternal goitre
- hyperplastic nodule
- colloid nodule
- thyroid adenoma
- thyroid cyst
- thyroid carcinoma
- hashimoto
asymptomatic neck swelling
rarely causes pain
thyroid mass moves witth swallow
bloods: TFT
imaging USS
special FNA
