Neck Masses Flashcards
Neck mass by age
Most likely inflammatory or neoplastic
- 0-16yrs
- 16-40yrs
- 40+yrs
What percent of non-thyroid neck masses in 40+ are malignant?
Most likely inflammatory or neoplastic
- 0-16yrs - Inflammatory
- 16-40yrs - Inflammatory
- 40+yrs - Neoplastic
What percent of non-thyroid neck masses in 40+ are malignant?
- 80%
Neck mass by location
Midline
Anterior
Posterior
Neck mass by location
Midline
- Plunging ranula (inflam)
- Thyroid mass (neoplasm)
- Thyroglossal duct cyst (congential)
- Dermoid cyst (congenital)
- Lymphoma (neoplasm)
Anterior
- Sialadenitis
- Lymphadenitis
- Branchial cleft cyst (congenital)
- Met
- Lymphoma
- Salivary gland tumor
- Carotid body tumor
- Schwannoma
Posterior
- Lymphangioma (congenital)
- Scrofula
- Lymphoma (Turberculosis)
- Met
Infection
- Most common microbe
- Microbe in cat-scratch
- Microbe in scrofula
Infection
- Streph / Staph = common microbe
- Bartonella henselae = Microbe in cat-scratch
- Mycobacterium tuberculosis = Microbe in scrofula
Infection
Viral (4)
Parasitic (1), found where?
Fungal (1) found where?
Infection
Viral (4)
- EBV, HIV, HSV, CMV
Parasitic (1), found where?
- Toxoplasmosis gondii (cat feces)
Fungal (1) found where?
- Coccidiodies immitis, southwest USA, respiratory
Lymphangioma
- What age does it appear
- Which neck triangle? Posterior to which muscle?
- Treatment
Lymphangioma
- Present at birth, continues to grow
- Posterior to SCM (posterior triangle)
- Treatment: sclerotherapy + excision if disfiguring/impairs function
Branchial cleft cyst
- Present at what age?
- Location
- Which branch is most common
- Treatment
- What causes them to suddenly increase in size?
Branchial cleft cyst
- Present at birth
- 2nd branch most common 95%
- Treatment: Sometimes surgery is required, recurrence common, may include tonsillectomy if 2nd branch
- Can be asymptomatic until infected causing sudden rapid growth
Most common developmental/congenital cyst in neck
Most common developmental/congenital cyst in neck
Thyroglossal duct cyst
- Thyroglossal duct cyst
- Present at what age
- Clinical presentation
- Key diagnostic manuever during exam
- Location
- Treatment
Thyroglossal duct cyst
Present at what age
- present at birth
Clinical presentation
- Size increase after URTI
Key diagnostic manuever during exam
- Moves with tongue protrusion/swallowing
Location
- Midline neck superior to hyoid
Treatment
- Sistrunk (Excision with midbody of hyoid)
Dermoid Cyst
- Present at what age
- Clinical presentation
- Key diagnostic manuever during exam
- Location
- Treatment
Present at birth, includes all three germ layers
Clinical presentation
- Painless, doughy, slow growing
Key diagnostic manuever during exam
- Does not move with tongue protrusion/swallowing
Location
- Midline neck/FOM
Treatment
- Excision
Thyroid mass - inflammatory
- Two diseases
- Which is most common
- Treatment for each
Thyroid mass - inflammatory
Two diseases
- Goiter (nutritional deficiency, puberty, pregnancy)
- Hashimotos
Which is most common
- Hashimotos (15% of all women)
Treatment for each
- Hashimotos = Thyroid hormone
- Goiter = depends on etiology
Thyroid mass - neoplasm
- Which age group is mostly benign
- Which age group is mostly malignant
- Clinical differentiation benign vs malignant
- Most common benign lesion
- Most common malignant lesion
- Second most common malignant lesion
- Which is associated with MEN 2A/2B
- Which is associated with hashimotos
- Which secretes calcitonin
- Which has a poor prognosis
- Which has psammoma bodies
Thyroid mass - neoplasm
- Children = Which age group is mostly benign
- Adult = Which age group is mostly malignant
- Benign is firm and fixed = Clinical differentiation benign vs malignant
- Adenoma = Most common benign lesion
- Papillary adenocarcinoma = Most common malignant lesion
- Follicular adenocarcinoma = Second most common malignant lesion
- Medullary carcinoma = Which is associated with MEN 2A/2B
- Lymphoma = Which is associated with hashimotos
- Medullary carcinoma = Which secretes calcitonin
- Anaplastic = Which has a poor prognosis
- Papillary adenocarcinoma = Which has psammoma bodies
Carotid body tumor
- What type of neoplasm?
- Location
- Clinical symptoms
Carotid body tumor
- Neuroendocrine tumor
- Anterior neck on medial aspect of bifurcation
- Clinical symptoms due to nerve compression
- Tongue paresis (CN XII)
- Hoarseness (recurrent laryngeal)
- Horner Syndrome (sympathetic nerve trunk)
- Dysphagia (CN IX)
Horner syndrome
- Which system is impaired?
- Clinical symptoms
- Management
Horner syndrome
- Impaired sympathetic
- Clinical symptoms are therefore unapposed parasympathetic
- Miosis, Anhydris (no sweating), eyelid ptosis (Muller’s muscle)
- Management
