Neck Lumps - Cystic hygroma, Thyroglossal cyst, Branchial cyst, Reactive lymph nodes, Lymphadenitis, Lymphoma

Question 1

Red flags for neck lump
-what may they suggest

Answer 1

Head and neck malignancy
-hard, painful, fixed
-associated ear pain, dysphagia, stridor, hoarse voice
-unilateral nasal symptoms (epistaxis, discharge, congestion)
-B symptoms
-cranial nerve palsies

Lumps larger than 2cm in children

Question 2

Possible causes of neck lump

Answer 2

Infective
-reactive lymphadenopathy

Neoplastic
-lymphoma or mets

AI
-thyroid disease

Congenital
-cystic hygroma
-thyroglossal cist
-branchial cyst

Question 3

Key investigations for suspicious neck lump

Answer 3

US with/without FNA
If needed, can do CT/MRI and bloods

Question 4

Cystic hygroma
-what is it
-associations
-presentation
-investigations

Answer 4

Congenital benign tumour of lymphatic system
-often in posterior triangle of neck
-infants

Turners
Alcohol abuse
Viral illness in pregnancy

Soft, compressible, not painful
No movement on swallowing
Transillumination
May affect breathing

Rule out malignancy - US, FNA

Observation - may be small, static, slowly regress
Surgical excision

Question 5

Thyroglossal cyst
-what is it
-presentation
-management

Answer 5

MOST COMMON TYPE OF CONGENITAL NECK MASS
-1-5 years

Midline, painless, mobile, fluctuant
-moves up with swallowing or protrusion of tongue
Painful, red if infected

If infected => ABx
Definitive => surgical removal

Question 6

Branchial cyst
-what is it
-presentation
-investigations
-management

Answer 6

Benign developmental defect of branchial arch
-fluid filled
-late childhood/early adulthood

Asymptomatic
Lateral, anterior to SCM
Smooth, soft, fluctuant, non-tender
May enlarge after resp infection
May have fistula
No movement on swallowing
No transillumination

Consider and exclude other malignancy
ENT referral - US, FNA

Conservative management
-ABx if infected
Surgical excision by ENT

Question 7

Lymphadenitis
-what is it
-presentations
-investigations
-management

Answer 7

When viruses/bacteria are transported into the lymph nodes

Unilateral/bilateral
Flu-like, strep throat like
Red, tender skin
Swollen, tender, hard
Fever
Rubbery if inflammed

US - if abscess found, must be drained

ABx - bacterial infection
Analgesia, cool compress
NSAIDs

Question 8

Reactive lymphadenopathy
-what is it
-presentation
-investigations
-management

Answer 8

Lymph nodes respond to infection => swollen

Recent URTI, dental, skin, ear infection
-pea/golf ball sized swelling
-tender
-soft
-mobile

US - can help distinguish between reactive and malignant

Self limiting - watch out for lymphadenitis

Question 9

Lymphoma
-what is it
-presentation
-investigations
-management

Answer 9

Uncontrolled proliferation of lymphocytes

Painless
Asymmetrical
B symptoms

V URGENT REFERRAL WITHIN 48HRS for HODGKIN WITH UNEXPLAINED LYMPHADENOPATHY
FBC - anemic, lymphopenic, thrombocytopenic
US, LN excision biopsy
PETCT - staging

Chemo, RT