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Gwen - ENT > Throat - NECK LUMPS > Flashcards

Throat - NECK LUMPS Flashcards

1
Q

Describe the boudaries of the anterior triangle

A

Superiorly: Mandible

Posteriorly: SCM

Anteriorly: Midline of the neck

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2
Q

Contents of anteior triangle

A

ECA, CN 9/10/12, Submandibular + Submental nodes

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3
Q

Boundaries of posterior triangle

A
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4
Q

Contents of posterior triangle

A

CN II, cervical nerve plexus, EJV, accessory nerve

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5
Q

Investigation of choice for neck lumps?

A

First choice investigation for neck lumps= FNA + Cytology (+/- USS)

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6
Q

What is the differential diagnosis for midline neck masses?

A

Submental reactive lymphadenopathy

Plunging ranula

Thyroglossal cyst

Thyroid mass (goitre)

Pharyngeal pouch

Dermoid cysts

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7
Q

What are thyroglossal cysts?

A

Congenital cystic remnant of the thyroglossal tract (runs from foramen caecum to thyroid gland)

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8
Q

Presentation of thyroglossal cyst

A

Smooth fluctuant painless lump MOVES UP on tongue protrusion (NOTE: thyroid lumps do not move on protrusion)

May become infected and therefore become tender

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9
Q

Management of thyroglossal cyst

A

Surgical excision although chance of recurrence

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10
Q

Differential of thyroid mass

A

Single (solitary) nodule- 10% malignant

  • Cyst
  • Adenoma (benign)
  • Malignancy
  • Prominent nodule in multinodular goitre

Goitre

  • Smooth non-toxic goitre- endemic
  • Smooth toxic goitre- graves, De Quervain’s
  • Multinodular colloid goitre- most common
  • Toxic multinodular goitre

ASK YOURSELF: is thyroid smooth or nodular? Is the pateint euthyroid, thryotoxic or hypothyroid?

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11
Q

What are dermoid cysts

A

Congenital defects in fusion of the midline of the skin - Contains tissue and cells normally present in skin layers including hair follicles, sebaceous (skin oil) + sweat glands

The gland and tissue secrete their normal substances and therefore closing cyst to grow

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12
Q

If an u20 year old presented with a midline swelling what is it likely to be?

A

Dermoid cysts, doesnt move up on tongue protrusion/swallowing

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13
Q

What is the differential diagnosis for lateral neck masses?

A

Reactive lymphadenopathy Lymphoma Salivary gland enlargement Branchial cyst Cystic hygroma Carotid aneurysm Thyroid mass Cervical rib

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14
Q

Differentials anterior triangle lumps

A

LN’s

Branchial Cyst

Laryngoceles

Carotid artery aneurysm

Carotid Body Tumour

Parotid Tumour

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15
Q

What is a branchial cyst?

A

Congenital non-disappearance of the second bronchial cleft in embryonic development

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16
Q

Describe presentation and investigations of branchial cysts

A

Smooth non-tender, fluctuant swelling in anterior triangle Cyst may enlarge following URTI

FNA- creamy fluid (CHOLESTEROL CRYSTALS)

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17
Q

Management branchial cyst

A

Surgical - excision

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18
Q

What are laryngoceles

A

Uncommon cause of anterior triangle lumps

Painless and may worse on blowing

May be associated with laryngeal cancer

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19
Q

Describe carotid artery aneurysm

A

Localised pulsating and laterally expansile

20
Q

What is a carotid body tumour (chemodectoma)

A

Tumour of carotid body chemoreceptors arising in the carotid bifurcation

21
Q

Describe presentation of chemodectoma

A

Firm/occasionally soft + PULSATILE + non tender

Can be moved side to side but not up and down

Pressure on tumour may cause dizziness and syncope by stimulating vagal tone via carotid sinus

Suspected in any mass, just anterior to the upper 1/3rd of SCM

V rare - would be surgically excised

22
Q

Differentials posterior triangle lump

A

Cystic Higroma

Pancoast Tumour

Cervical Ribs

Pharyngeal Pouch

23
Q

What is a cystic higroma

A

Congenital benign proliferation of lymph vessels that is found in posterior triangle - derived from jugular lymph sac

Presentation:

  • Present at birth
  • Multi-cystic swelling that is fleshy + compressible (+ contains clear fluid)
  • Characteristically: transluminate brightly
24
Q

Cause of pancoats tumour

A

Apical lung cancer:

  • Invades sympathetic plexus (ipsilateral Horner’s)
  • +/- Brachial plexus (Arm pain)
  • Recurrent laryngeal nerve (hoarse voice/bovine cough)
25
Q

Differential submandibular triangle lumps

A

Duct calculus

Parotiditis

Pleomorphic Adenoma

26
Q

Causes of enlarged salivary glands

A

Acute viral infection (mumps)- bilateral acute swelling

Acute bacterial infection (parotiditis)

Calculi + distal infection (submandibular)

Sjogrens syndrome -Chronic bilateral symptoms, dry eyes + mouth +/- Sjogrens

Tumours

27
Q

Causes of parotiditis

A

Aetiology- infection, stone, tumour, viral (mumps)

Pathology- inflammation of parotid gland

Presentation- one or bilateral

28
Q

Whats the 80% rule in salivary gland tumours?

A

80% are in parotid

80% are pleomorphic adenomas

80% are in superficial lobe

29
Q

Presentation of pleomorphic adenoma

A

Middle age and grows slowly, hard and PAINLESS

30
Q
A
31
Q

What is the most common cause of neck swelling?

A

Reactive lymphadenopathy

32
Q

What is the mnemonic for remembering the causes of lymphadenopathy?

A

Mnemonic: HODGKINS DISEASE H aematological: Hodgkins lymphoma, NHL, Leukaemia O ncological: metastases D ermatopathic lymphadenitis G aucher’s disease K awasaki disease I nfections: TB, glandular fever, Syphilis N iemann Pick disease S erum sickness - reaction to proteins in antiserum derived from a non-human animal source D rug reaction (phenytoin) I mmunological (RA) S arcoidosis E ndocrinological (Hyperthyroidism) A ngioimmunoplastic lymphadenopathy S LE E osinophilic granulomatosis

33
Q

What are the features of a neck lump that would make you suspect lymphoma?

A

Rubbery, painless lymphadenopathy Some report lump becomes painful when drinking alcohol Associated with nights sweats and splenomegaly

34
Q

What are the features of a neck lump that would make you suspect a thyroid swelling?

A

Moves upwards when patient swallows Symptoms of hypo- or hyper-thyroidism

35
Q
A
36
Q

What are the features of a neck lump that would make you suspect a thyroglossal cyst?

A

Usually midline, between isthmus of the thyroid and the hyoid bone Moves upwards with protrusion of tongue May be painful if infected More common in patients under 20

37
Q

What are the features of a neck lump that would make you suspect a pharyngeal pouch?

A

Usually not seen but if large then a midline lump in the neck that gurgles on palpation Typical symptoms are dysphagia, regurgitation, aspiration, chronic cough and halitosis (bad breath) More common in older men

38
Q

What is a pharyngeal pouch?

A

A pharyngeal pouch is a posteromedial diverticulum through Killian’s dehiscence. Killian’s dehiscence is a triangular area in the wall of the pharynx between the thyropharyngeus and cricopharyngeus muscles. It is more common in older patients and is 5 times more common in men

39
Q

What are the features of a neck lump that would make you suspect a cystic hygroma?

A

Typically found in left posterior triangle of the neck Most are evident at birth, around 90% present before 2 years of age

40
Q

What is a cystic hygroma?

A

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side

41
Q

What are the features of a neck lump that would make you suspect a branchial cyst?

A

Oval, mobile cystic mass Develops between sternocleidomastoid muscle and pharynx Usually present in early adulthood

42
Q

What is a branchial cyst?

A

A congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.

43
Q

What are the features of a neck lump that would make you suspect a cervical rib?

A

Hard, non mobile Situated above first rib

44
Q

What is a cervical rib?

A

Extra rib which arises from the seventh cervical vertebra. Sometimes known as “neck ribs”, their presence is a congenital abnormality located above the normal first rib. A cervical rib is estimated to occur in 0.6% (1 in 150 people) to 0.8% of the population. People may have a cervical rib on the right, left or both sides.

45
Q

Which group more commonly develop a cervical rib?

A

Females

46
Q

What is the main complications of a cervical rib?

A

Thoracic outlet syndrome: either compression of the brachial plexus or compression of the subclavian artery.

47
Q

What are the clinical features of thoracic outlet syndrome?

A

Compression of the brachial plexus may be identified by weakness of the muscles around the muscles in the hand, near the base of the thumb. Compression of the subclavian artery is often diagnosed by finding a positive Adson’s sign on examination, where the radial pulse in the arm is lost during abduction and external rotation of the shoulder.

Gwen - ENT (13 decks)

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