The Differential Diagnosis of Neck Lumps

Question 1

What is the superficial structure diagnosis for a neck lump?

Answer 1

• Skin abscess
• Lipoma
• Dermoid cyst

Question 2

What are the midline differentials for a neck lump?

Answer 2

• Thyroglossal cyst
• Thyroid swelling
• Submental lymph node
• Sublingual dermoid cyst

Question 3

What are the anterior triangle differential diagnosis?

Answer 3

• Lymphadenopathy
• Submandibular gland
• Tail of parotid gland swelling
• Branchial and lymphoepithelial cysts
• Thyroid lobe swellings

Question 4

What is the surgical sieve for neck lump diagnosis?

Answer 4

• Developmental: branchial cleft and cyst, haemangiomas and lymphangiomas
• Infectious: granulomatous, TB, cat scratch disease, lesions dental infection
• Neoplastic: benign (salivary, thyroid, soft tissues), malignant (thyroid, soft tissues, local metastases, distant metastases)

T = trauma
I = infection / inflammation / iatrogenic
N = neoplasm
C = congenital
A = autoimmune
M = metabolic
B = bone / bowel / brain
E = endocrine
D = degenerative
O = other

Question 5

What are some history questions to ask someone with a neck lump?

Answer 5

• How long has it been there for?
• Have you noticed it changing size?
• Have they had any systemic illness?
• Any contact with infectious disease? e.g. HIV, syphilis
• Have they had any symptoms of recurrent fever, lassitude, B symptoms and anaemia?
• Have they had any drugs such as phenytonin?

Question 6

What investigations should be undertaken for neck lump differential diagnosis?

Answer 6

Full blood count - leukemia/glandular fever

Is anaemia present?

Chest radiograph for mediastinal nodes e.g. hodgkin disease, sarcoidosis

Serology (HIV/glandular fever)

Fine needle aspiration e.g. primary/secondary neoplasm or tuberculosis

Question 7

What are the main bacterial and viral causes of cervical lymphadenopathy?

Answer 7

Bacterial
Dental: apical abscess, cellulitis, periodontitis, pericoronitis, tuberculosis, syphilis

Viral: herpetic stomatitis, infectious mononucleosis, HIV infection, childhood fevers

Question 8

What are the causes of thyroid lumps?

Answer 8

• Multinodular goitre
• Benign neoplasm
• Malignant neoplasm: follicular, papillary, medullary
• Diffuse enlargement (iodine deficiency, autoimmune thyroiditis)