Neck Masses and Lymph Nodes Flashcards
How are thyroglossal duct cysts formed?
When the thyroglossal duct tract persists and fails to close
Where are thyroglossal duct cysts located?
MIDLINE anywhere from the base of the tongue to the thyroid isthmus
CP of thyroglossal duct cysts?
- Usually found prior to age 10
- Painful
- Palpable
- Dysphagia
Where do thyroglossal duct cysts occur in relation to strap muscles?
Medial to strap muscles
SF of thyroglossal duct cyst?
- Midline cystic structure
- Anechoic or complex
- Typically <3cm
Where does the branchial cleft extend from?
Pharyngeal cavity to an opening near the auricle or neck
What 3 abnormalities may form from a branchial cleft?
- Cysts
- Sinuses
- Fistulas
Are branchial cleft cysts usually singular or multiple and unilateral or bilateral?
Singular and unilateral
Which branchial cleft cyst is most common?
2nd type: upper/anterior or adjacent to SCM muscle
Where are the 1st branchial cleft cysts located?
Type 1: Auditory canal
Type 2: Submandibular area
Where are the 2nd branchial cleft cysts located?
Are the most common type and located upper/anterior or adjacent to SCM muscle
Where are the 3rd branchial cleft cysts located?
Rare and located DEEP to the SCM
Where are the 4th branchial cleft cysts located?
Rare and variable location
Branchial cleft cysts are considered where in the neck?
Lateral neck masses
CP of branchial cleft cysts?
- Palpable neck masses
- Tender with infection
SF of branchial cleft cysts?
VARIABLE:
1. Anechoic (most common)
2. Homogenous
3. Heterogrenous
4. Hypoechoic
5. Pseudosolid
What does pseudosolid mean?
A structure on ultrasound that appears solid but is actually cystic and contains fluid
What is the most common appearance of branchial cleft cyst?
Anechoic
What abnormality results from a developmental error in the cervical lymphatic system?
Cystic hygroma
Cystic hygroma’s have a strong association with which chromosomal abnormalities?
- Trisomy 21
- Trisomy 18
- Turner syndrome
Most common cause of deep neck space infections in both adults and children?
Adults: Dental issues/infections
Children: Tonsilitis
What are the three most common spaces for abscesses?
- Submandibular
- Retropharyngeal
- Parapharyngeal
Patient presents with pain, difficulty swallowing, and has recently had dental work done, what is the most likely diagnosis?
Deep neck space infection
What is the gold standard to evaluate deep neck space infections?
CT
Describe phlegmon vs. abscess?
Phlegmon = UNCONTAINED area of inflammation and can spread to adjacent structures
Abscess = walled off collection of puss and is confined to an area. Usually contains thickened walls
What is most likely to spread to nearby structures: abscess or phlegmon?
Phlegmon because it is uncontained
In what population are lymph nodes harder to see?
Older
What is the normal appearance of a lymph node?
- Round or oval
- Hypoechoic
- Hilar vascularity
- echogenic fatty hilum
- Generally about 1cm in size AP
SF of an abnormal lymph node?
- Round
- Hypoechoic
- Cystic necrosis within
- Chaotic vascularity
- Increased size
- Absence of fatty hilum
What does cystic necrosis mean?
An area of dead tissue that has undergone liquefaction and results in a cystic appearance
Appearance of a lymph node as a result of metastases from papillary thyroid carcinoma?
- Hyperechoic lymph nodes
- Calcifications within
What is the largest lymph node in the body?
Jugulodigastric
Most common causes for lymphadenopathy? (hint: 3)
- Autoimmune
- Infection
- Neoplastic
