Neck Masses

Question 1

Name 6 differentials for midline neck mass

Answer 1

• Submental lymph node
• thyroglossal cyst
• thyroid nodule in isthmus
• sublingual dermoid cyst
• plunging ranula (retention cyst of sublingual ) - congenital or acquired trauma
• rare: hyoid pathology eg bursa

Question 2

Name 8 differentials for anterior triangle neck mass

Answer 2

• lymph node along anterior border SCM
• thyroid nodule
• submandibular gland mass
• branchial cyst or fistula - FNA will yield opalescent fluid with cholesterol crystals.
• chemodectoma (carotid body paraganglionoma tumour) - small risk malignancy. Firm. At level hyoid bone where carotid bifurcate. Do gentle palpation, can cause syncope. Pulsatile. Differential aneurysm. Don’t do Fna! Ct. Excision or radiotherapy.
• carotid aneurysm
• pharyngeal pouch = Zenker’s diverticulum - herniate pharyngeal mucosa between thyropharangeus and cricopharyngeus through Killian’s dehiscence. Squelching sound on deep palpation. Halitosis, regurg, hoarse. Can cause chest infect, neoplasm. DX ba swallow
• laryngocoele ( rare, air filled compressible)

Question 3

Name 4 differentials for posterior triangle neck mass

Answer 3

• Lymph node - post SCM, sypraclavicular
• cystic hygroma (congenital lymphatic malformation) - transilluminates
• cervical rib - cause thoracic outlet syndrome: pallor, gangrene, necrosis fingers; oedema, cyanosis; radicular symptoms, wasting small muscles hand. Adson’s test - extend neck and rotate towards side symptoms, radial pulse diminished.
• brachial plexus neuroma/schwannoma - do not do fna, very painful