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Neck Masses Flashcards

1
Q

Describe the etiology & risk factors of a branchial cleft cyst

A
  • MC congenital neck mass in kids
  • 2-3% bilateral, clusters
  • unknown embryonic changes during gestation
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2
Q

Describe the clinical presentation of a branchial cleft cyst

A
  • 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
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3
Q

Describe the treatment for branchial cleft cyst

A

refer to ENT for surgical excision (can lead to infection)

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4
Q

Describe the etiology/risk factors for thyroglossal duct cysts

A
  • midline anterior neck mass from leftover thyroid cells
  • usually in childhood prior to 10 y/o
  • embryonic remnant from failure of thyroglossal duct closure
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5
Q

Describe the clinical presentation of thyroglossal duct cysts

A
  • can be asymptomatic
  • dysphagia if enlarged or infected
  • may go undiagnosed until ill
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6
Q

Describe the treatment for thyroglossal duct cysts

A

refer to ENT for surgical removal (1-2% can have carcinoma)

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7
Q

Describe the etiology/risk factors for viral adenopathy

A
  • most common cause of neck masses in peds
  • adenovirus, rhinovirus, enterovirus, influenza, HSV, CMV, EBV
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8
Q

Describe the clinical presentation of viral adenopathy

A
  • 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
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9
Q

Describe the treatment for viral adenopathy

A

treat symptoms

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10
Q

Describe the etiology/risk factors for bacterial lymphadenopathy

A
  • usually suppurative LAD from skin/pharynx
  • staph aureus, GABHS most common, MRSA if recent hosp, anaerobic from dental procedure, mycobacterium from soil/water
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11
Q

Describe the clinical presentation of bacterial lymphadenopathy

A

bilateral tender soft/rubbery submandibular lymph node groups

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12
Q

Describe the diagnostic testing for bacterial lymphadenopathy

A

WBC, CRP, procalc, BC, rapid strep test

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13
Q

Describe the etiology/risk factors for parotitis

A
  • inflammation of parotid gland
  • bacterial (staph or anaerobe) or viral
  • secondary to new anticholinergic med, post op, dehydration, poor dental hygiene
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14
Q

Describe the clinical presentation of parotitis

A
  • sialadentitis: inflammation of salivary gland
  • firm, swollen, tender, parotid gland
  • f/s/c
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15
Q

Describe the diagnostic testing for parotitis

A

amylase, WBC, PCR, +/- CT

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16
Q

Describe the treatment for parotitis

A
  • inpt for severely ill pts with IV abx
  • OP with oral abx (clindamycin + ciprofloxacin)
  • hydration, massage, sialogogues, peridex
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17
Q

Describe the etiology/risk factors for sarcoidosis

A

autoimmune, tiny clusters of inflammatory cell granulomas collecting in the lungs, nodes, eyes, skin
- overreaction to resp tract exposure
- 20-40, F>M

18
Q

Describe the clinical presentation of sarcoidosis

A
  • hard palpable lymph node, usually in posterior triangle or supraclavicular space
  • long term prodrome usually accompanying (fatigue)
19
Q

Describe the diagnostic testing for sarcoidosis

A
  • ACE levels and CRP elevated
  • CT neck/chest, EBUS biopsy, skin biopsy
20
Q

Describe the treatment for sarcoidosis

A

refer to pulm for long term care
- prednisone, immunosuppressants, observation

21
Q

Describe the etiology/risk factors for thyroid masses

A

anterior neck mass/goiter (inflammation of thyroid)
- nodules, hard thyroid mass

22
Q

Describe the clinical presentation of thyroid masses

A

goiter, hard nodules in thyroid, asymptomatic or symptoms related to TSH

23
Q

Describe the diagnostic testing for thyroid masses

A

TSH, T3, T4, thyroid ultrasound

24
Q

Describe the treatment for thyroid masses

A

fine needle aspiration if indicated

annual ultrasounds (5% are cancerous)

25
Describe the etiology/risk factors for salivary gland neoplasms
- 80% parotid gland, 20% submandibular or lingual glands - 80% benign, 20% malignant
26
Describe the clinical presentation of salivary gland neoplasms
- usually benign asymptomatic growing masses - malignancy causes pain, skin changes, affects cranial nerves
27
Describe the diagnostic testing and treatment for salivary gland neoplasms
- CT, FNA - refer to onc/surgery
28
Describe the etiology/risk factors for parangangliomas
- vascular tumors occurring anywhere from sympathetic or parasympathetic nerves - carotid body tumor most common - 75% sporadic
29
Describe the clinical presentation of parangangliomas
- pulsatile mass felt and bruit heard - Fontaine's sign: move horizontally but not vertically
30
Describe the diagnostic testing and treatment for paragangliomas
- MRI/MRA - surgical removal
31
Describe the etiology/risk factors for Schwannoma
- tumor on any peripheral nerve - usually the vagus nerve or cervical sympathetic chain
32
Describe the clinical presentation of paragangliomas
- slow growing mass in neck - hoarseness, aspiration, Horner's syndrome
33
Describe the diagnostic testing and treatment of Schwannomas
- MRI/MRA - surgical removal
34
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
35
Describe the clinical presentation of non-hodgkin lymphoma
- f/s/c - weight loss - itching - fatigue - malaise - oncologic emergency
36
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
37
Describe the diagnostic testing for lymphomas
- CT neck, FNA, core biopsy - CBC, procalcitonin, throat culture, ESR/CRP, PCR, HIV, TB
38
Describe the diagnostic tests for non-hodgkin's lymphoma
elevated LDH, uric acid, lactic acid
39
Describe the diagnostic tests for hodgkin's lymphoma
reed sternberg cells seen on pathology
40
Describe the treatment of lymphoma
refer to oncology for chemo/radiation, surgical excision

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