Neck lumps Flashcards
What questions would you ask to characterise a neck lump?
- What is its site?
- What is its size?
- What is its shape?
- Is it smooth or lobulated?
- Is it in the midline?
- Is it solid or cystic?
- Is there more than one lump?
- Is it tender?
- Is it attached to any viscus or skin?
- Is it connected to the thyroid and therefore moves on swallowing?
- Is it pulsatile?
- Is there any associated acute or chronic inflammation or ulceration anywhere within the head & neck?
How would you investigate a neck lump?
FBC, ESR, WBC 🡪 infection
Monospot/Paul Bunnell test 🡪 infectious mononucleosis
- Antibody test for EBV
- But also examine axilla & groin for LN and check for liver & spleen enlargement
HIV screen
Radiology: CT, chest X-ray, ultrasound, MRI, PET
Cytology – fine needle aspiration cytology (FNAC) (only 3 month validity, need stop aspirin 5 days prior)
Endoscopy – to look for primary site of tumour
Biopsy (excisional) -> biopsy of cancerous lesions may lead to tumour cells seeding in soft tissue if incisional approach is used
Bethesda classification (thyroid) for reporting FNACs – suggestive prognosis + Mx
where is a brachial cyst normally located?
Young men 20-30yo, with a neck mass at junction between upper 1/3 and lower 2/3 of SCM, occurring anteriorly to SCM (around level 2)
What is a dermoid cyst??
- Painless midline swellings, along embryological lines of fusion
Do not move on swallowing or tongue protrusion, cannot be separated from overlying skin - Due to defects of fusion in embryo – elements of skin trapped subcutaneously and develop into cysts lined with squamous epithelium & skin appendages
- Congenital: Ectodermal elements can trapped within the mesodermal layers. Usually midline, due to embryological development
- Acquired: gunshot wound or trauma (bits of skin trapped inside)
What is a cystic hygroma?
- Rare type of lymphangioma (benign tumour of lymph vessels) where vessels are very large & dilated
- Usually noticed at or soon after birth, may be very large (can compress vital structures within the neck)
