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Head and neck > Neck lump differentials > Flashcards

Neck lump differentials Flashcards

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1
Q

what should you look for in a history when being presented with a neck lump

A
  • history
    • age ( in cbildren enlarged lympnode is likely secondary to infection
    • duration, progression, associated symptoms and signs e.g. red flags
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2
Q

what should look for when examining a neck lump

A
  • relate locatio to knowledge of underlying structures
  • anteriro or psoteiror triagnle? Mdiline or laterally placed?
  • movement with swallowing and sticking out tongue
  • palpation
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3
Q

features to look for when palpating neck tumour

A
  • does it feel superifical or deep
  • mobile or immobile
  • hard/soft/smooth/irregular
  • tender (inflamed/infected lumps are painful)
  • overlying skin changes e.g. red
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4
Q
A
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5
Q

what are some of the possible causes of neck lumps

A
  • superficial e.g. sebacaeous cyst, dermoid cyst, lipoma, skin abscess
  • inflammaotry/infective lymph node e.g. tonsilitis, mouth ulcer
  • congenital lesions e.g. thryoglossal and branchial cysts, laryngocele
  • thryoid pathology - malignant or bening
  • primary (e.g. lymphoma) or secondary malignant (metastatic) disease involving the lymph node
  • salivary gland pathology (calculus, infection, tumour)
  • other e.g. chronic infection (TB, HIV) can cause lympahdenopathy, also carotid artery aneurysm
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6
Q

name some superifical causes of enck lumps

A

sebacious cysts, dermoid cyst, lipoma

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7
Q

name some causes of inflammatory/infective lymph nodes

A

tonsilitis, mouth ulcers

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8
Q

name some congenital causes of nekc lumps

A

thyroglossal cysts, branchial cysts, laryngocoele

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9
Q

thyroid pathology can be

A

malignant or benign

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10
Q

primary cancer of the lymph node

A

lymphoma

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11
Q

secondary malignancy of the neck lymph node

A

metastatic

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12
Q

supraclavicular node drain the

A

thorax and abdomen- Virchows node (think of johnny)

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13
Q

salivary gland patholgoy

A

calculus, infection, tumour

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14
Q

other causes of neck lumps

A

chronic infection (TB, HIV)

carotid artery aneurysm

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15
Q

Lymphadenopathy is very common case for neck lumps. They can be caused due to:

A
  1. Infection (most common)
    • Tender and mobile
  2. Malignancy
    • Hard, matted, non-tender
    • Or rubbery, moviel and fast growing
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16
Q

relationship between superifical and deep lymph nodes

A

superfical lymph nodes (more readily palpable) drain into the deep lymph nodes within the carotid sheath

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17
Q

deep lymph nodes most associated with

A

internal jgual vein along its length within the carotid sheath

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18
Q

Key areas for lymph nodes on the face, scalp and neck

A
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19
Q

what tests could you do on a pt that presents with a neck lump

A
  • FBC
  • virology serology
  • chest x-ray
  • throat swab
  • FNAB (fine needle aspiration biopsy)
  • ultrasound
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20
Q

what are some possible differentials for a neck lump apart from lymphoma

Study These Flashcards
A

lipoma, thymoma

21
Q

what area do the supraclavicular nodes drain

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A

-overswe transport of lymph frpm the thoracic cavidy and abdomen

left node= abdomen and thorax (virchows node)

right node= mid section chest, oesophagus and lungs

22
Q

what initital imaging choice for a neck lump and why

Study These Flashcards
A

US

  • can see superficial
  • no radiation
  • can biopsy
23
Q

red flags for lymphadenopathy

Study These Flashcards
A
  • persisting >6 weeks
  • fixed hard and irregular
  • rapidly growing in size
  • associated with generalised lymphadenopathy- check other node groups
  • systemic signs/sympotms e.g. weight loss or night sweats (TB or lymphoma)
  • associated with a peristent change in voice/ hoarseness or difficulty swallowing (pharynx or larynx cancer)
24
Q

differentials of a lateral neck lump

Study These Flashcards
A

Submandibular triangle

  • reactive lymphadneopathy (children)
  • submandibular gland disease e.g. stone

Anterior triangle

  • reactive lymphadenopathy (children)
  • neoplastic lymphadenopathy (firm, non-tender, older)
  • Branchial cyst
  • lateral thryoid masses
  • parotid gland disease
  • laryngeocoel

Posterior triangle

  • reactive lymphadenopathy (younger)
  • neoplastic lymphadenopathy (firm, non-tender, older)
  • lipoma
  • cervical rib
25
Branchial cyst
26
branchial cyst
* lateral to midline in the anterior triangle * in front of SCM (superficial) * congenital- remnant of second branchial cleft * does not move on swallowing
27
28
midlien lymp differentials
* thryoglossal duct cyst * dermoid cyst * thyroid pathology * general lympadenopathy
29
thyroglossal duct cysts
* near hyoid * pea sized cyst * when the connection between the tongue and thyroid is never lost * **stick tongue out will move**
30
dermoid cyst
congenital will not move on swallowing
31
thyroid pathology
- cancer - goitre ( TSH, T3/T4) - will move on swallowing
32
33
how can you tell the difference between this beign a lipoma and goitre
* cant get fingers around goitre * moves up when swallowif if a goitre
34
typical history of extradural haemorrhage
defined head injury any age, lose consciousness intitially but then wake up and fine, lucid intevral, deterioration usually an arterial bleed e.g. middle meningeal artery- sits below the thinnest part of the skull
35
typical history of subdural haemorrhage
Venous bleed from bridging veins * Can fill subdural spaces old, minor head injury days before as venous blood flow is slow, confusion
36
typical history of subarachnoid haemorrhage
* Secondary to trauma or spontaneous rupture of blood vessel e.g. aneurysm * Usually a branch of the Circle of Willis (arterial circuit responsible for supplying brain structures) * Blood leaks into subarachnoid space, mixing with CSF- sudden, often fatal worst headache ever had, nauseous vomiting, meningism, patient often has hypertension, sudden
37
typical history of subapneurotic haemorrhage
scalp Subgaleal hemorrhage is a rare but potentially lethal condition found in newborns. 1. It is caused by rupture of the emissary veins, which are connections between the dural sinuses and the scalp veins. Blood accumulates between the epicranial aponeurosis of the scalp and the periosteum
38
where does blood cpollect in extradural haemorrhage
Is a collection of blood in the 'potential' space between the skull and the outer protective lining that covers the brain (the dura mater).
39
extradural haemorrhage on CT
biconvex associated wuth fracture (75%)
40
subdural haemorrhage usually associated with
[traumatic brain injury](https://en.wikipedia.org/wiki/Traumatic_brain_injury)—gathers between the inner layer of the [dura mater](https://en.wikipedia.org/wiki/Dura_mater) and the [arachnoid mater](https://en.wikipedia.org/wiki/Arachnoid_mater) of the [meninges](https://en.wikipedia.org/wiki/Meninges) surrounding the [brain](https://en.wikipedia.org/wiki/Brain). It usually results from tears in [bridging veins](https://en.wikipedia.org/wiki/Bridging_vein)that cross the [subdural space](https://en.wikipedia.org/wiki/Subdural_space).
41
subdual haemorrhage on CT
crescentic
42
chronic subdural haemorrhage
confusion
43
acute subdural haemorrhage
e.g. car crash
44
subarachnoid haemorrhage is due to what sort of bleed
e.g. intracerebral aneurysm- circle of willis
45
subarachnoid on CT
* 93% picked up if within 24 hours * 100% if within 6 hours * Lumbar puncture if CT inconclusive: sample CSF to identify presence of blood (GHb degradation products) central hyperdensity within subarachnoid
46
Extradural hematoma
extradural hematoma occurs when blood accumulates between your skull and the outermost covering of your brain. It **typically follows a head injury, and usually with a skull fracture e.g. at the pterion--\> bleeding of the MMMA.** High-pressure bleeding is a prominent feature. If you have an epidural hematoma, you may briefly lose consciousness and then regain consciousness.
47
Subdural hematoma
A subdural hematoma is a collection of blood on the surface of your brain. It’s typically the result of your head moving rapidly forward and stopping, such as in a car accident. However, it could also suggest abuse in children. This is the same type of movement a child experiences when being shaken. A subdural hematoma is more common than other ICHs in older people and people with history of heavy alcohol use.
48
Subarachnoid hemorrhage
A subarachnoid hemorrhage is when there’s bleeding between the brain and the thin tissues that cover the brain. These tissues are called meninges. The most common cause is trauma, but it can also be caused by rupture of a major blood vessel in the brain, such as from an intracerebral aneurysm. A sudden, sharp headache usually comes before a subarachnoid hemorrhage. Typical symptoms also include loss of consciousness and vomiting.
49

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