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NECK LUMPS Flashcards

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1
Q

What is contained within the anterior triangle of the neck?

A

Carotid arteries
Internal jugular vein
Vagus nerve
Salivary glands
Muscles of the floor of the mouth
Larynx
Trachea
Hypopharynx
Oesophagus
Cervical lymph nodes

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2
Q

What is contained within the posterior triangle of the neck?

A

Accessory nerve
Cervical nerve plexus
Fibre fatty lymphatic tissues
Brachial plexus
Subclavian artery

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3
Q

Examination of a neck lump

A

Inspection - site, size, shape, overlying skin, mobility, related to structures
Scars
Skin changes
Tongue protrusion (thyroglossal cyst)
Swallowing (thyroid goitre)

Palpate lump - may check for transillumination and bruit also
Palpate lymph nodes

Inspect upper aerodigestive tract - oropharyngeal exam and then a trans nasal endoscope examination

Palpate thyroid gland
Palpate submandibular gland

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4
Q

What is a branchial cyst?

A

A benign, developmental defect of the branchial arches. Develop due to failure of obliteration of the second branchial cleft in embryonic development The cyst is filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium.

They can have a fistula and therefore be prone to infection

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5
Q

When do branchial cysts present and how?

A

Late childhood or early adulthood

Present as asymptomatic unilateral, oval mobile lump usually anterior to sternocleidomastoid near the angle of the mandible - slowly enlarging, smooth, soft, fluctuant, no movement on swallowing and no transillumination

Typically presents in young adults when an upper RTI causes it to increase in size. May also be painful during acute infection

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6
Q

Investigtaions to consider for ?branchial cyst?

A

consider and exclude other malignancy
ultrasound
referral to ENT
fine-needle aspiration

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7
Q

Treatment for branchial cysts?

A

ENT surgeons manage them conservatively or surgically remove them

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8
Q

DDx for a neck lump in a child?

A

congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation, cystic hygroma
inflammatory: reactive lymphadenopathy, lymphadenitis,
neoplastic: lymphoma, thyroid tumour, salivary gland tumour

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9
Q

What is a cystic hygroma?

A

A lymphangioma - a congenital benign lymphatic lesion typically identified prenatally or at birth (90% before age 2)

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10
Q

How do cystic hygromas present?

A

Typically found on the left side of the neck

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11
Q

Whats the most common benign neck lump?

A

A lipoma

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12
Q

How does a lipoma in the neck feel?

A

Painless
Soft
Mobile
Discrete subcutaneous mass

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13
Q

Whats the most common type of skin cyst?

A

Epidermoid/sebaceous

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14
Q

How do sebaceous cysts present?

A

Smooth, spherical or dome shaped, firm, mobile but tethered to epidermis.
Covered with normal epidermis but may appear yellow or white and there may be creamy discharge

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15
Q

How common are thyroid nodules?

A

In 3-7% of adults

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16
Q

Types of benign thyroid nodules?

A

Colloid nodules
Hyperplasticity nodules
Cysts
Follicular adenomas

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17
Q

Types of malignant thyroid cancers?

A

Papillary
Follicular
Medullary
Anaplastic

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18
Q

Where are most of salivary gland tumours found?

A

80% found in the parotid gland

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19
Q

In which salivary glands is risk of malignancy highest?

A

Submandibular and minor salivary glands

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20
Q

How do benign salivary gland tumours present?

A

Solitary neck mass
Well-defined
Painless
Slow-growing
Mobile

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21
Q

How do malignant salivary gland tumours present?

A

Solitary neck lump
Painful
Rapid growth
Skin fixation
Paraesthesia
Facial nerve involvement

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22
Q

Types of maligannt salivary glands tumours?

A

Much epidermoid carcinoma
Adenocarcinoma
Metastatic SCC of face or scalp

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23
Q

Whats the most common congenital cyst?

A

A thyroglossal cyst

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24
Q

Who are thyroglossal cysts usually found in?

A

Adults <20

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25
How do thyroglossal cysts present?
Slow growing lump - may grow rapidly after an URTI Mid-line Well-defined Not tethered to underlying skin Non-tender Moves upwards when sticking tongue out May also become secondarily infected and present as an inflammatory swelling
26
What is a thyroglossal cyst?
A cyst arising from persistent epithelial tissue along the thyroglossal embryological pathway - most commonly found in the midline between the isthmus of the thyroid and the hyoid bone
27
How does a dermoid cyst present?
In children and young adults - superficial mid-line well-defined soft painless and tethered to underlying skin
28
What is ectopic thyroid tissue?
Thyroid gland tissue not located in the usual location
29
What is a laryngocele? how does it present?
A rare, benign unilateral dilatation of the laryngeal saccule A reducible tense mass that can increase in size during sneezing or nose blowing
30
What is a pharyngeal diverticulum?
Aka zenkers diverticulum A pharyngeal pouch more common in old men Its a posteromedial herniation between the thyropharyngeus and the cricopharyngeus muscles
31
Presentation of a pharyngeal diverticulum?
Not usually visible but if large they may have a midline neck lump. It gurgles on palpation Dysphagia Regurgitation Aspiration Chronic cough Halitosis
32
Whats the most likely cause of neck lumps in children?
Lymphadenopathy
33
What can cause lymphadenopathy?
Inflammation Infection Dental problems Trauma Malignancy - leukaemia, lymphoma, mets Amyloidosis, Sarcoidosis, CTD, TB, catscratch disease
34
Presentation of leukaemia?
Generalised lymphadenopathy Splenomegaly Pallor Fatigue Fever Persistent infection Bruising Bleeding
35
Presentation of lymphoma?
Painless, rubbery, soft mobile lymphadenopathy that grows rapidly - most commonly in posterior triangle Fever Night sweats Fatigue Weight loss Later may get diffuse lymphadenopathy and hepatosplenomegaly
36
What gland is most commonly affected by sialedenitis?
Parotid gland
37
Who is sialedenitis most common in?
Older people with dehydration or following dental procedures
38
What causes sialedenitis?
Most commonly bacterial - staph aureus Viral - mumps, HIV
39
Symptoms of sialedenitis?
Rapid onset pain and swelling Local erythema Oedema Localised tenderness Bimanual compression towards the duct opening may cause purulent discharge into the oral cavity
40
What can cause chronic obstructive sialadeneitis?
Obstruction of the duct and reduced salivary flow e..g by a stone or structure Granulomatous diseae e.g. TB or sarcoidosis Autoimmune disease e.g. sjogrens
41
What gland is most commonly affected by sialolithiasis?
The submandibular gland
42
How does sialolithiasis present?
Swelling and tenderness for mins/hours that worsens when eating
43
Who is a cervical rib most likely to affect?
40 year old thin women with a long neck and drooping shoulders After neck trauma or pt with anatomical predispositions e.g. cervical rib
44
What complication do 10% of pt with a cervical rib get?
Thoracic outlet syndrome
45
What is thoracic outlet syndrome?
Compression of the brachial plexus, subclavian vein or artery at the site of thoracic outlet
46
Whats more common, vascular or neurogenic thoracic outlet syndrome?
Vascular - accounts for 90% of cases
47
How does vascular thoracic outlet syndrome present?
If veins… Painful, diffuse arm swelling with distended veins If artery… Painful arm claudication ulceration and ganagrne
48
How does neurogenic thoracic outlet syndrome present?
Painless muscle wasting Hand weakness Numbness Tingling Cold hands Blanching Swelling
49
What is a carotid body tumour?
a highly vascular paraganglioma that arises from the paraganglion cells of the carotid body. It is located at the carotid bifurcation
50
How does a carotid body tumour present?
Slow-growing painless swelling in upper anterior triangle of the neck Pulsating Compressible Has a bruit or thrill Can be moved form side to side but not up or down Does not move on swallowing
51
What can cause pre and post auricular lymphadenopathy?
Scalp infections Mycobacteria infection Scalp neoplasm Head and neck SCC Lymphoma
52
What can cause supraclavicular lymphadenopathy?
Abdominal or thoracic neoplasm Thyroid disease Laryngeal disease Mycobacterium/Fungal infections
53
What can cause submandibular and anterior cervical lymphadenopathy?
Mononucleosis URTI Mycobacterium infection Toxoplasmosis CMV Dental disease Rubella SCC of head and neck Leukaemias Lymphoma
54
What are the characteristics of abnormal lymph nodes?
>1.5cm in juguladigastric area or >1cm elsewhere >3cm may suggest malignancy Rapid increase in size
55
Who should you arrange a 2WW for with a thyroid lump?
An unexplained thyroid lump. A thyroid mass associated with unexplained hoarseness or voice change. A thyroid mass associated with cervical lymphadenopathy or supraclavicular lymphadenopathy. Sudden onset of a rapidly expanding painless thyroid mass, significantly increasing in size over days and weeks. A suspected thyroid nodule with other red flags or risk factors for malignancy. A suspected thyroid nodule with associated compressive symptoms, such as breathlessness or dysphagia.
56
What should you do if you find an unexplained persistent neck lump in someone >45?
2WW
57
What should you do if you find an unexplained enlarging neck lump in someone >25?
Urgent neck USS within 2 weeks
58
What should you do if you find an unexplained enlarging neck lump in someone <25?
Very urgent neck USS within 48 hours
59
What are red flags for a neck lump?
Hard and fixed lump Persistent or rapidly growing lymph node >3cn Pt is >35 Presence of a mucosa lesion Persistent hoarseness or dysphagia Presence of trismus Ipsilateral otalgia Fatigue, night sweats, fever, weight loss, bruising, bleeding, infections, alcohol-induced pain
60
If a neck lump transilluminates what is it likely to be?
Fluid-filled e.g. a cystic hygroma
61
Investigtaions for a neck lump?
TFTs Routine bloods - FBC, U&Es, CRP USS or other imaging Fine needle aspiration Referral to ENT
62
Causes of a midline neck lump?
Lymph node Lipoma Dermoid cyst Epidermoid cyst Enlarged thyroid gland Thyroid nodule Thyroglossal cyst Laryngocele
63
Causes of a neck lump in the anterior triangle?
Lymph node Lipoma Epidermoid cyst Submandibular gland swelling Branchial cyst Carotid artery aneurysm Carotid body tumour Laryngocele
64
Causes of neck lumps in the posterior triangle?
Lymph node Lipoma Epidermoid cyst Subclavian aretry aneurysm Pharyngeal pouch Cystic hygroma - typically on the left Branchial cyst Mass in the tail of the parotid gland e.g. plemorphic adenoma or primary parotid malignancy

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