Session 1 - Cervical Lymph Nodes and Neck Lumps Flashcards
Main actions of the lymphatic system.
Remove excess fluid from interstitial space
Return small proteins including pathogens and fluid that leaked from capillaries.
Immune defence and immune surveillance.
Source of lymphocytes.
Most common regions of the body where collections of lymph nodes may be palpable.
Neck (cervical)
Armpit (axillary)
Groin (femoral)
Most common cause of enlarged lymph node?
Other common cause?
Lymphadenopathy (remember this is just a manifestation of an underlying cause)
Lymphoedema.
Common causes of lymphadenopathy.
Infection (most common)
Malignancy
Difference in representation between lymphadenopathy due to infection and malignancy.
Infection: A tender and mobile lump
Malignancy: Hard and non-tender + irregular lump. It can also be rubbery, mobile and fast-growing.
What are regional and terminal lymph nodes?
Regional are superficial lymph nodes and terminal lymph nodes are deep nodes.
Which lymph nodes drain to which?
Regional/superficial drain to deep/terminal.
Where would accumulation of fluid in superficial fascia of the neck drain?
First to superficial lymph nodes and then to deep lymph nodes.
Where would accumulation of fluid or pathology in infrahyoids, thyroid gland, larynx/trachea, pharynx/oesophagus drain to?
Immediately to deep node since it is already deep of superficial fascia.
Where would you find superficial lymph nodes?
In superficial fascia.
Where would you find deep lymph nodes?
In the carotid sheath.
Name the superficial lymph nodes.
Submental LNS Submandibular LNS Preaurical LNS Postaurical LNS Occipital LNS Superficial cervical Posterior cervical Anterior cervical
How do superficial lymph nodes differ from deep lymph nodes upon examination?
A swelling of a superficial lymph node will be more noticeable than a swelling of a deep lymph node.
Where can you find the deep lymph nodes?
Deep to sternocleidomastoid muscle and closely related to IJV and carotid sheath.
Most important deep lymph nodes of the neck.
Jugulo-digastric
Jugulo-omohyoid
Supraclavicular lymph nodes
Where would a cold sore on the inside of your bottom lip drain to? (Which lymph node might be enlarged?)
Submental
A patient comes in with conjunctivitis. Which lymph nodes might be enlarged?
Preaurical
Patient comes in with tonsillitis. Which lymph nodes might be enlarged?
Jugulo-digastric
Patient comes in with tongue malignancy. Which lymph nodes might be enlarged?
Jugulo-digastric or jugulo-omohyoid
What is Waldeyer’s ring?
An annular collection (ring collection) of lymphoid tissue that surrounds the upper aerodigestive tract.
Which lymphoid tissues does the Waldeyer’s ring consist of?
Pharyngeal tonsil (adenoids) Tubal tonsil Palatine tonsil (source of tonsillitis) Lingual tonsils (found at the base of the tongue)
What history is important in dx diagnosis of neck lumps?
Age
Duration
Progression
Associated symptoms and signs
Why is age important?
Infective/inflamed neck lumps are most common in children. (More retropharyngeal space and less likely to be malignancy)
In elderly people there is an increasing probability that a neck lump will be due to malignancy.
Upon examination, what is important in dx diagnosis of neck lumps?
Location
Movement upon swallowing or sticking out tongue
Palpation (Does it feel superficial or deep, is it hard/soft/smooth or irregular, is it fixed, tender, or and overlying skin changes?)
Possible causes of neck lumps.
Superficial likes sebaceous cyst, dermoid cyst, lipoma or skin abscess.
Inflammatory or infective lymph node like tonsillitis or mouth ulcer.
Congenital lesions like thyroglossal duct cysts or branchial cysts.
Thyroid pathology
Primary or secondary malignancies
Salivary gland pathology
TB, HIV etc…
Common midline neck lumps.
Dermoid cyst
Thyroglossal duct cyst
Thyroid gland pathology
Common lateral neck lumps.
Branchial cyst
Salivary gland pathology
What is a dermoid cyst?
A congenital cyst of epithelial origin.
Usually fixed by surgery and will not move upon swallowing.
Most commonly appears in early childhood.
What is a thyroglossal duct cyst?
A congenital cyst formed upon the development of the thyroid gland at the base of the tongue. Usually midline and will move upon protrusion of tongue or swallowing.
Red flags for lymphadenopathy.
Persisting over 6 weeks
Fixed, hard and irregular
Rapidly growing in size
Associated with generalised lymphadenopathy
Associated systemic signs and symptoms like weight loss and night sweats.
Associated with a persistent (unexplained) change in voice/hoarseness or difficulty swallowing.
What is usually the first-line imaging choice for investigating a neck lump?
Ultrasound.
The jugulo-omohyoid node is mainly associated with what lymph drainage?
Tongue Oral cavity Trachea Oesophagus Thyroid gland
What can malignancies of the abdomen and thorax result in? (Think lymph nodes)
Enlargement of supraclavicular lymph nodes.
Drainage of fluid from abdomen and thorax all the way to venous circ.
Supraclavicular lymph nodes to thoracic duct into left subclavian vein.
Examples of midline lumps.
Dermoid cysts
Thyroglossal cyst
Thyroid lump
Lymphadenopathy
Examples of lateral neck lumps of the submandibular triangle.
Reactive lymphadenopathy (younger age) Submandibular gland disease
Examples of lateral neck lumps of the anterior triangle.
Reactive lymphadenopathy Neoplastic lymphadenopathy Branchial cyst Thyroid masses Parotid gland disease Paraganglioma Laryngocoele Cystic hygroma/lymphangioma Carotid bulb
Examples of lateral neck lumps of the posterior triangle.
Reactive lymphadenopathy
Neoplastic lymphadenopathy
Lipoma
Cervical rib
Characteristics of haemangiomas and lymphangiomas.
Congenital lesions usually present within first years of life.
Haemangiomas may spontaneously resolve.
Lympangiomas are often soft, doughy, and ill-defined and may present with pressure effects.
Haemangiomas often appear bluish.
Treatment of haemangiomas.
Surgical treatment is most commonly reserved for lesions with rapid growth involving vital structures in case medical therapy.
Treatment of lymphangiomas.
Injection with picibanil or excision for easily accessible lesions or those affecting vital functions.
Characteristics of sebaceous cysts.
Most often in older people.
Slow growing usually. Can be painful if infected.
Biopsy confirms diagnosis.
Characteristics of branchial cleft cysts.
Present as a smooth, fluctuant mass.
Often appear rapidly after upper respiratory tract infection.
Treatment is usually control of infection.
