Neck Masses Flashcards
Describe the etiology & risk factors of a branchial cleft cyst
- MC congenital neck mass in kids
- 2-3% bilateral, clusters
- unknown embryonic changes during gestation
Describe the clinical presentation of a branchial cleft cyst
- fluctuant fluid filled sac of epithelial cells and lymph cells anterior to the SCM
- can present with URI sxs
- can develop fistula to skin/sinus
Describe the treatment for branchial cleft cyst
refer to ENT for surgical excision (can lead to infection)
Describe the etiology/risk factors for thyroglossal duct cysts
- midline anterior neck mass from leftover thyroid cells
- usually in childhood prior to 10 y/o
- embryonic remnant from failure of thyroglossal duct closure
Describe the clinical presentation of thyroglossal duct cysts
- can be asymptomatic
- dysphagia if enlarged or infected
- may go undiagnosed until ill
Describe the treatment for thyroglossal duct cysts
refer to ENT for surgical removal (1-2% can have carcinoma)
Describe the etiology/risk factors for viral adenopathy
- most common cause of neck masses in peds
- adenovirus, rhinovirus, enterovirus, influenza, HSV, CMV, EBV
Describe the clinical presentation of viral adenopathy
- bilateral, tender, soft/rubbery submandibular lymph node groups
- 1-1.5cm in size
- sometimes constitutional sxs, myalgia, diarrhea, conjunctivitis, oral sores, rash, h/a, otalgia
Describe the treatment for viral adenopathy
treat symptoms
Describe the etiology/risk factors for bacterial lymphadenopathy
- usually suppurative LAD from skin/pharynx
- staph aureus, GABHS most common, MRSA if recent hosp, anaerobic from dental procedure, mycobacterium from soil/water
Describe the clinical presentation of bacterial lymphadenopathy
bilateral tender soft/rubbery submandibular lymph node groups
Describe the diagnostic testing for bacterial lymphadenopathy
WBC, CRP, procalc, BC, rapid strep test
Describe the etiology/risk factors for parotitis
- inflammation of parotid gland
- bacterial (staph or anaerobe) or viral
- secondary to new anticholinergic med, post op, dehydration, poor dental hygiene
Describe the clinical presentation of parotitis
- sialadentitis: inflammation of salivary gland
- firm, swollen, tender, parotid gland
- f/s/c
Describe the diagnostic testing for parotitis
amylase, WBC, PCR, +/- CT
Describe the treatment for parotitis
- inpt for severely ill pts with IV abx
- OP with oral abx (clindamycin + ciprofloxacin)
- hydration, massage, sialogogues, peridex
Describe the etiology/risk factors for sarcoidosis
autoimmune, tiny clusters of inflammatory cell granulomas collecting in the lungs, nodes, eyes, skin
- overreaction to resp tract exposure
- 20-40, F>M
Describe the clinical presentation of sarcoidosis
- hard palpable lymph node, usually in posterior triangle or supraclavicular space
- long term prodrome usually accompanying (fatigue)
Describe the diagnostic testing for sarcoidosis
- ACE levels and CRP elevated
- CT neck/chest, EBUS biopsy, skin biopsy
Describe the treatment for sarcoidosis
refer to pulm for long term care
- prednisone, immunosuppressants, observation
Describe the etiology/risk factors for thyroid masses
anterior neck mass/goiter (inflammation of thyroid)
- nodules, hard thyroid mass
Describe the clinical presentation of thyroid masses
goiter, hard nodules in thyroid, asymptomatic or symptoms related to TSH
Describe the diagnostic testing for thyroid masses
TSH, T3, T4, thyroid ultrasound
Describe the treatment for thyroid masses
fine needle aspiration if indicated
annual ultrasounds (5% are cancerous)
Describe the etiology/risk factors for salivary gland neoplasms
- 80% parotid gland, 20% submandibular or lingual glands
- 80% benign, 20% malignant
Describe the clinical presentation of salivary gland neoplasms
- usually benign asymptomatic growing masses
- malignancy causes pain, skin changes, affects cranial nerves
Describe the diagnostic testing and treatment for salivary gland neoplasms
- CT, FNA
- refer to onc/surgery
Describe the etiology/risk factors for parangangliomas
- vascular tumors occurring anywhere from sympathetic or parasympathetic nerves
- carotid body tumor most common
- 75% sporadic
Describe the clinical presentation of parangangliomas
- pulsatile mass felt and bruit heard
- Fontaine’s sign: move horizontally but not vertically
Describe the diagnostic testing and treatment for paragangliomas
- MRI/MRA
- surgical removal
Describe the etiology/risk factors for Schwannoma
- tumor on any peripheral nerve
- usually the vagus nerve or cervical sympathetic chain
Describe the clinical presentation of paragangliomas
- slow growing mass in neck
- hoarseness, aspiration, Horner’s syndrome
Describe the diagnostic testing and treatment of Schwannomas
- MRI/MRA
- surgical removal
Describe the etiology/risk factors of lymphomas
- malignancy of lymphocytes (T, B, NK)
- aggressive non-hodgkins (Burkitts) more common than Hodgkins in kids
- indolent lymphomas more common than aggressive NHL and HL
- RF: immunodeficiency, EBV, fam hx, pesticide exposure
Describe the clinical presentation of non-hodgkin lymphoma
- f/s/c
- weight loss
- itching
- fatigue
- malaise
- oncologic emergency
Describe the clinical presentation of hodgkin’s lymphoma
- 70% mediastinal mass
- f/s/c
- malaise
- fatigue
- chest pain
- rubbery painless lymph nodes in cervical/supraclavicular space
Describe the diagnostic testing for lymphomas
- CT neck, FNA, core biopsy
- CBC, procalcitonin, throat culture, ESR/CRP, PCR, HIV, TB
Describe the diagnostic tests for non-hodgkin’s lymphoma
elevated LDH, uric acid, lactic acid
Describe the diagnostic tests for hodgkin’s lymphoma
reed sternberg cells seen on pathology
Describe the treatment of lymphoma
refer to oncology for chemo/radiation, surgical excision
