Neck swellings Flashcards
What are the congenital neck swellings?
- cystic hygroma
- branchial cyst
- thyroglossal cyst
a neonate presented with a large translucent cystic mass on the side of his neck, what is the reason behind this condition?
coarse lymphangioma
congenital dilation of neck lymphatics
CYSTIC HYGROMA
How should cystic hygroma be treated?
injection of sclerosing agent
failure of obliteration of 2nd branchial cleft will lead to?
cystic mass under the cover of sternomastoid
BRANCHIAL CYST
What are the complications of a branchial cyst & how is it treated?
fistula formation (acquired) surgical excision
failure of thyroglossal trunk obliteration will lead to?
THYROGLOSSAL CYST
Where does a thyroglossal cyst commonly occur?
subhyoid area
What sign will be seen with a thyroglossal cyst?
moves up & down with deglutition & TONGUE PROTRUSION
what are the complications of a thyroglossal cyst?
infection
fistula formation
What are the investigations performed incase of a thyroglossal cyst & what is its treatment?
- ultrasound neck
- radioisotopic scanning
- SISTRUNK operation
What is your diagnosis if a patient presents to u with a pulsatile swelling under sternomastoid & what investigation will you use to reach it?
- CAROTID ARTERY ANEURYSM
- CT angiography will show abnormal permanent dilation of artery
a patient presents to your clinic with a tense soft swelling attached to the skin with a puntum, what is your diagnosis?
sebaceous cyst caused by retention
How is a sebaceous cyst treated?
surgical excision through elliptical incision
a patient presents with a soft swelling with a slippery edge & not attached to the skin, what might be your diagnosis & treatment?
LIPOMA
subcutaneous benign tumor of adipose tissue
surgical enucleation
a patient presents with a hot red tender swelling that’s fluctuant, what is your diagnosis & treatment?
ABSCESS
acute localized suppurative infection
incision & drainage
What may cause a lymph node swelling?
inflammation (lymphadenitis)
malignancy (lymphoma or malignant metastasis)
CERVICAL LYMPHADENOPATHY most common
How can a lymph node swelling be identified?
anatomical sites
multiple & rolling
DIAGNOSE BY FNAC
How can you differentiate between an inflamed LN & a metastatic LN?
INFLAMED METASTATIC
- tender - not tender
- mobile - fixed
- firm or rubbery - hard
- discrete - amalgamated
a baby with a history of birth trauma presented to your clinic with a unilateral sternomastoid hard mass & head tilt on the same side, what could be your diagnosis and how do u confirm it?
STERNOMASTOID TUMOR Congenital torticollis
- diagnosed by neck US
What is the management of a sternomastoid tumor?
may resolve spontaneously but needs physiotherapy or surgical division of sternal head of muscle
a patient presents with a butterfly shaped swelling infront of the neck that moves up & down with deglutition, what is your diagnosis?
GOITER
what is the herniation of pharyngeal mucosa through Killian’s triangle named?
Zenker’s diverticulum
What is the cause of Zenker’s diverticulum?
spasm of cricopharyngeus muscle –> increase intrapharyngeal pressure –> herniation through weak point
What are the signs & symptom’s of Zenker’s diverticulum?
- progressive dysphagia
- regurgitation of undigested food
- +/- swelling on LEFT side of the neck that increases with eating
- soft & compressible with gurgling sensation
What is the method of investigation used in Zenker’s diverticulum?
Barium swallow –> flask shaped pouch
endoscopy DANGEROUS
How can we differentiate a parotid swelling?
elevation of ear lobule
diagnose by neck US & CT
What complications could a parotid swelling cause?
facial nerve palsy
How can we differentiate a submandibular swelling?
- no rolling during palpation
- only 1 swelling
- palpated by manually (from floor of the mouth)
- NECK US
How should a submandibular swelling be treated?
submandibular sialoadenectomy
a large mucus retention cyst in the floor of the mouth is called?
A Ranula
Who is most affected by Ranulas?
children & young adults
What are the distinguishing factors of a Ranula?
- ruptures & refills usually
- bluish & translucent
- smooth & covered with tortous veins
How is a ranula treated?
Marsupialization
a tumor in the chemoreceptors in the carotid body is called?
Potato tumor
How can a potato tumor be distinguished?
- solid & hard
- pulsate (transmission from carotid artery)
- CT ANGIOGRAPHY of neck
What is the treatment of a carotid body tumor?
surgical excision +/- reconstruction of carotid vessels
