Week 3 - D - Week 3 - thyroid neck lumps - goitre, thyroglossal duct/dermoid/branchial cyst, cystic hygroma, pleomorphic adenoma Flashcards
What is the likely cause of this child’s goitre?
Iodine deficiency causing hypothyroidism and therefore goitre forming
Worldwide, too little iodine in the diet is the most common cause of hypothyroidism.
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in countries with sufficient dietary iodine
What are the boundaries of the anterior triangle of the neck?
Boundaries Superiorly - mandible
Medially - midline is boundary
Laterally - bounded by anterior border of sternocleidomastoid (SCM) muscle
What are the boundaries of the posterior triangle of the neck?
Anteriorly - posterior border of the SCM muscle
Posteriorly - anterior border of trapezius muscle
Inferiorly - clavicle
What type of swelling is the category for :
- Sebaceous Cysts - large protruding pocket-like lesion filled with sebum
- Lipomas
- Neurofibromas
Superficial swellings
What are the three usual causes of a midline neck swelling?
Thyroid
Thyroglossal cyst
Dermoid cyst
What midline swelling moves on swallowing?
Thyroid swelling and Thyroglossal duct cyst
How does a thyroglossal duct cyst present? How do you test for a thyroglossal duct cyst?
* most often in individuals under 20..
* Appears as painless swelling in midline of neck or on posterior aspect of tongue. Moves with swallowing
* And moves with sticking out/protruding tongue - helps differentiate it from a thyroid swelling
Should the neck be extended or flexed when carrying out a neck examination?
Slightly extended
What is the most common cause of a neck swelling?
Lymph node enlargement
Lymph node swelling accounts for ~85% of all neck swellings, what is the second most common cause?
Goitre - diffuse swelling of the thyroid gland
When examining a patient with cervical lymphadenpathy, what should you remember to look for?
Look for other nodes
Look for other sites
Look for hepatosplenomegaly
If the cervical lymphadenopathy presents with a general swelling, ie lypmh node swelling is not restricted to the neck, where should you check?
Check the liver and spleen
A thyroglossal cyst can arise in any part of the thyroglossal tract What age group does it usually present in? How do you check for it on examination?
Usually presents in teenages - less than 20years old
Ask patient to swallow - could be a thyroid swelling or thyroglossal cyst then -
* Ask patient to stick out their tongue and see if the swelling moves - it should move if it is a thyroglossal cyst
What is the name of the rare congenital cyst that usually presents in teenage years? It is soft and midline
Dermoid cyst
Cyst presenting in upper part of anterior triangle, can fistulate causing leakage out of the neck What is this called?
Branchial cyst
Cyst most commonly found in the posterior triangle of the neck and the armpits Usually found in first year of life What is this?
This cyst is called a cystic hygroma - a macroscopic lymphangioma
The cyst is lymph filled and can cause pressure on other structures
What can help differentiate a cystic hygroma from a branchial cyst?
Cystic hygroma appears in the posterior triangle of the neck or armpit usually within first year of life
Branchial cyst typically appears in the anterior triangle of the neck as an adolescent / young adult
Cystic hygroma trans-illuminates as ti contains clear fluid
What is the most common tumour of the partoid gland? It is the also the most common type of salivary gland tumour
Pleomorphic adenoma
Can cause infection
