PEDIATRICS Section 3: Head and Neck Flashcards
Embryology wise, the thyroid starts where?
at the back of the tongue and descends downward to a location that would be considered normal.
What represents the persistence of the inferior portion of the thyroglossal duct?
“Pyramidal lobe”
What happens when normal descent of the tongue gets fucked up?
The thyroid either:
Stays at the back of the tongue (lingual thyroid)
or
Ends up halfway down the neck or even in the chest (Ectopic thyroid)
How do you diagnose ectopic tissue?
Nukes (I-23 or Tc-MIBI) –> superior
next is CT
What is the most common locationof ectopic thyroid tissue?
Lingular thyroid (back of the tongue)
What is the embryological thyroid interstate highway to the neck?
Failure to involute fully results in?
Thyroglossal duct
Cyst (Thyroglossal duct) - hence the name
Classic location of Thyroglossal duct cyst
- Base of the tongue
- Midline anterior to the hyoid
Diagnosis?
Thyroglossal Duct Cyst
“MIDLINE” cyst in the neck of a Kid
Thyroglossal Duct Cyst
Next step after you looke for Midline cyst in the neck of a kid?
Confirm Normal thyroid location and/or look for ectopic tissue (USD +/- Tc-MIBI or I-123)
If you see a nodule within a suspected cyst in the midline cyst in the neck of a kid - consider?
CANCER (usually papillary
Sign of infection in Thyroglossal duct cyst
Rim enhancement + Fatty stranding
Management for Thyroglossal Duct Cyst
Sistrunk Procedure - Remove cyst, tract + hyoid = decreases recurrence
Where do dermoid cyst usually occur? but when they happen in the neck, what will be the classic look?
It is true that dermoids almost always occur below the clavicles, but when they do happen in the neck they have a pretty classic look; midline sublingual / submandibular space with a “sac of marbles” appearance.
Diagnosis? Describe
Dermoid cys- marbles of lobules of fat within the fluid
What is the most common branchial cleft cyst?
2nd Branchial clef cyst (95%)
Classic location of branchial cleft cyst.
Angle of the mandible
Diagnosis? what is the sign?
Branchial cleft cyst
Extension of the cyst between ICA and ECA just above the carotid bifurcation - “Notch Sign”
Where is the 2nd branchial cleft cyst specifically located?
Posterior and lateral to the submandibular gland or lateral to the carotid space, or anterior to the sternocleidomastoid
REMEMBER - Lateral to everything
2nd branchial cleft cyst buzzword
“LATERAL”
BCC (branchial cleft cyst) mimics
Necrotic level 2 lymph node
Thyroid CA (History of radiation exposure)
NPC (History of HPV) - Early adulthood
If you have a new Branchial cleft cyst in an 18 year old, what do you consider?
A necrotic node.
I say LATERAL cyst in the neck you say?
Branchial Cleft Cyst (BCC)
I say MIDLIN cyst in the neck, you say?
Thyroglossal duct cyst (TGDC)
What are the two jugular vein issues that occur in kids that are worth mentioning?
Septic Thrombophlebitis and Phlebectasia
a.k.a clotted jugular vein
Septic Thrombophlebitis
In what setting do you usually see Septic Thrombophlebitis?
recent pharyngeal infection (or recent ENT surgery)
is a rare complication of bacterial pharyngitis/tonsillitis and involves an extension of the infection into the lateral pharyngeal spaces of the neck with subsequent septic thrombophlebitis of the internal jugular vein(s)
Lemierre syndrome (LS)
After identifying Septic Thrombophlebitis, what should you do next?
Look for septic emboli in the lungs
What bacteria causes septic emboli?
Fusobacterium necrophorum
Diagnosis?
Lemierre Syndrome
Idiopathic dilated Jugular vein
Phlebectasia
A six-year-old child with no particular past medical history presented with a two-year history of progressively enlarging mass on the right side of the neck.
Diagnosis?
Phlebectasia
