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Head and Neck > Cervical lymph nodes and lymphadenopathy > Flashcards

Cervical lymph nodes and lymphadenopathy Flashcards

1
Q

What are the roles of the lymphatic system?

A

Remove excess tissue fluid

Return small proteins and fluid leaked from capillary

Immune defence & Surveillance - source of lymphocytes, physical barrier

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2
Q

What is lymphoedema?

A

Accumulation of tissue fluid
Usually in lower/upper limbs

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3
Q

What is lymphadenopathy?

A

Enlarged lymph nodes due to infection or malignancy (can be metastases or primary lymphoma)

common in neck

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4
Q

Why do pathologies sometimes lead to more than one lymph node being involved?

A

All material transported by lymph usually passes through AT LEAST 1 node before reaching venous circulation

This means things can spread via lymph

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5
Q

Types of filtering in lymph and what this can lead to

A

Physical filter
Phagocytic filter
Full of T and B lymphocytes - if proliferate can lead to enlargement

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6
Q

Regions where lymph nodes can be palpated

A

Neck
Groin
Axilla

some nodes even when enlarged cannot be palpated. some can be palpated even when not enlarged

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7
Q

What is Waldeyers ring?

A

Annular collection of lymphoid tissue (NOT NODES) surrounding the upper aerodigestive tract

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8
Q

Tonsils that make up Waldeyers ring

A

Pharyngeal tonsil/adenoids (top of nasopharyngeal area)

Tubal tonsil (just below)

Palatine tonsil (the ones we see and refer to)

Lingual tonsil (under posterior tongue)

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9
Q

Problem with enlargement of pharyngeal tonsil/adenoids

A

Common in children

Obstruction of nasal breathing - snoring/mouth breathing

Blockage of eustachian tube (leading to middle ear problems)

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10
Q

What is common cause for neck lump in children and adults?

A

Lymphadenopathy

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11
Q

In most cases, is lymphadenopathy a cause for concern?

A

No, most cases benign and self limiting caused by local infection of tissues drained by that lymph node

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12
Q

When should you be concerned about lymphadenopathy?

A

Risk of concern rises with age. Older you are = more likely to be something serious

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13
Q

Palpation findings for reactive (due to infection) lymphadenopathy

A

Tender
Mobile - does not feel stuck to tissues
Recent rapid enlargment

+ History suggests infective cause

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14
Q

Two reasons for lymphadenopathy

A

Reactive - infection
Malignancy

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15
Q

Palpation findings for secondary malignancy in node (metastases)

A

Hard - rock like
Tethered to surrounding tissues
Painless palpation

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16
Q

Palpation findings for primary malignancy eg lymphoma

A

Rubbery
Painless to palpate
Fast-growing

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17
Q

History from pt which suggests malignant cause for lymphadenopathy - Red flags

A

Weight loss
Night sweats
Persisting >6 weeks
Fixed, hard and irregular
Rapidly growing
Generalised lymphadenopathy (across body)
Unexplained change in voice/hoarseness or difficulty swallowing

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18
Q

Other places to palpate when pt comes in with lymphadenopathy

A

Spleen
Other palpable areas eg groin, neck and axilla

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19
Q

Where are the cervical lymph nodes located superficial vs deep?

A

Superficial lymph nodes are located within superficial cervical fascia, just beneath skin

Deep cervical lymph nodes are deeper within neck

20
Q

What are the deeper cervical lymph nodes often associated with?

A

Internal jugular vein - usually located along its length within carotid sheath - not always

21
Q

What do deep cervical lymph nodes take drainage from?

A

The superficial lymph nodes
Deeper tissues - within investing layer eg thyroid/oesophagus

22
Q

What do the superficial lymph nodes form?

A

Ring from chin to occipital bone

23
Q

5 Superficial lymph nodes in head

A

Submental - beneath chin

Submandibular - beneath jaw

Pre-auricular + Parotid - front of ear

Post auricular - behind ear

Occipital - back/base of scalp

24
Q

3 superficial lymph nodes in neck

A

Superficial cervical - on top of SCM muscle

Posterior cervical - behind SCM

Anterior cervical - anterior to SCM

25
Q

What are the superficial lymph nodes in the neck associated with?

A

Superficial - External jugular vein

Posterior - external jugular vein

Anterior - anterior jugular vein

(superficial to SCM muscle unlike IJV)

26
Q

What do the superficial lymph nodes do?

A

Drain tissues of face and scalp before draining into deeper tissues

27
Q

Submental drainage area

A

Inferior and posterior chin
Floor of mouth
Tip of tongue
Lower incisor teeth and gums

28
Q

Submandibular drainage area

A

Centre of face and cheek
Teeth and gingivae
Parts of anterior tongue

29
Q

Pre-auricular and parotid drainage area

A

Anterolateral scalp
Upper half of face, including eyelids
Cheeks

(large area - can get swelling here when pt’s have conjuctivits)

30
Q

Post auricular drainage area

A

Posterolateral half of scalp

31
Q

Occipital drainage area

A

Posterior scalp

32
Q

Tongue’s lymphatic drainage

A

Posterior 1/3rd of tongue drains to deep cervical lymph nodes

Anterior tongue drains to submental nodes below

33
Q

Deep cervical lymph nodes to note

A

Jugulo-digastric - just beneath mandible, swells with tonsilitis

Jugulo-omohyoid - near base of SCM

Supraclavicular lymph nodes - within supraclavicular fossa

34
Q

Where are the DCLN in relation to SCM

A

They are deep to the muscle (below it)

35
Q

Drainage of jugulo-digastric

A

Tonsils
Upper digestive tract tissues
Pharynx
Part of tongue

36
Q

Jugulo-omohyoid drainage

A

Part of tongue
Oral cavity
Trachea
Oesphagus
Thyroid gland

37
Q

Supraclavicular drainage

A

Thoracic and abdominal cavity - also receives drainage from whole body

38
Q

What can supraclavicular lymph node swelling indicate?

A

Disease below the neck - transport from thoracic cavity and abdomen

39
Q

What can swollen left supraclavicular node suggest?

A

Abdominal cavity and thorax enlarged
Virchow’s node
Suggests gastric cancer

40
Q

What can swollen right supraclavicular node suggest?

A

Mid section chest, oesophagus and lungs problem

41
Q

How to approach neck lump presentation?

A

History - age, duration, progression, associated symptoms (red flags?), risk factors eg H&N cancers

Examination - midline or lateral?
If lateral is it within anterior/posterior triangle?
Movement will swallowing - thyroid
Moves with sticking out tongue - thyroglossal duct cyst
PALPATE and note features

42
Q

Palpation questions to ask

A

Superfical?
Mobile or fixed?
Hard or soft?
Smooth or irregular?
Fluctaunt - filled with fluid?
Tender?
Overlying skin changes, redness?

43
Q

Causes of neck lumps

A

Benign lesions of skin/subcutaneous tissue (sebaceous cyst or lipoma)

Cervical lymphadenopathy (reactive or malignant)

Congenitial lesions (thyroglossal duct cysts, branchial cyst, dermoid cyst)

Thyroid gland pathology (malignant/benign neoplasms, disease eg Graves)

Salivary gland pathology - calculus (stone), inflammation/infection, neoplasm (B/M)

Vascular - carotid body tumour, carotid artery aneurysm IF PULSATILE - moves side to side but not up and down

44
Q

Midline neck lump causes

A

Thyroid gland disease

Congenital lesions - dermoid cyst/thyroglossal duct cyst

45
Q

Lateral neck lump causes

A

Salivary gland pathology
Carotid body tumour

Congenital lesions - branchial cyst, cystic hygroma

46
Q

First line imaging for investigating neck lump

A

Ultrasound - quick, easy, no radiation, can be used for guided fine needle aspiration

Head and Neck (26 decks)

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