NECK LUMPS Flashcards

1
Q

What is the differential diagnosis for midline neck masses?

A

Submental reactive lymphadenopathy

Plunging ranula

Thyroglossal cyst

Thyroid mass (goitre)

Pharyngeal pouch

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2
Q

What is the differential diagnosis for lateral neck masses?

A

Reactive lymphadenopathy

Lymphoma

Salivary gland enlargement

Branchial cyst

Cystic hygroma

Carotid aneurysm

Thyroid mass

Cervical rib

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3
Q

What is the most common cause of neck swelling?

A

Reactive lymphadenopathy

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4
Q

What is the mnemonic for remembering the causes of lymphadenopathy?

A

Mnemonic: HODGKINS DISEASE

H aematological: Hodgkins lymphoma, NHL, Leukaemia

O ncological: metastases

D ermatopathic lymphadenitis

G aucher’s disease

K awasaki disease

I nfections: TB, glandular fever, Syphilis

N iemann Pick disease

S erum sickness - reaction to proteins in antiserum derived from a non-human animal source

D rug reaction (phenytoin)

I mmunological (RA)

S arcoidosis

E ndocrinological (Hyperthyroidism)

A ngioimmunoplastic lymphadenopathy

S LE

E osinophilic granulomatosis

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5
Q

What are the features of a neck lump that would make you suspect lymphoma?

A

Rubbery, painless lymphadenopathy

Some report lump becomes painful when drinking alcohol

Associated with nights sweats and splenomegaly

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6
Q

What are the features of a neck lump that would make you suspect a thyroid swelling?

A

Moves upwards when patient swallows

Symptoms of hypo- or hyper-thyroidism

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7
Q

What are the features of a neck lump that would make you suspect a thyroglossal cyst?

A

Usually midline, between isthmus of the thyroid and the hyoid bone

Moves upwards with protrusion of tongue

May be painful if infected

More common in patients under 20

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8
Q

What are the features of a neck lump that would make you suspect a pharyngeal pouch?

A

Usually not seen but if large then a midline lump in the neck that gurgles on palpation

Typical symptoms are dysphagia, regurgitation, aspiration, chronic cough and halitosis (bad breath)

More common in older men

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9
Q

What is a pharyngeal pouch?

A

A pharyngeal pouch is a posteromedial diverticulum through Killian’s dehiscence. Killian’s dehiscence is a triangular area in the wall of the pharynx between the thyropharyngeus and cricopharyngeus muscles. It is more common in older patients and is 5 times more common in men

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10
Q

What are the features of a neck lump that would make you suspect a cystic hygroma?

A

Typically found in left posterior triangle of the neck

Most are evident at birth, around 90% present before 2 years of age

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11
Q

What is a cystic hygroma?

A

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side

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12
Q

What are the features of a neck lump that would make you suspect a branchial cyst?

A

Oval, mobile cystic mass

Develops between sternocleidomastoid muscle and pharynx

Usually present in early adulthood

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13
Q

What is a branchial cyst?

A

A congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.

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14
Q

What are the features of a neck lump that would make you suspect a cervical rib?

A

Hard, non mobile

Situated above first rib

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15
Q

What is a cervical rib?

A

Extra rib which arises from the seventh cervical vertebra. Sometimes known as “neck ribs”, their presence is a congenital abnormality located above the normal first rib. A cervical rib is estimated to occur in 0.6% (1 in 150 people) to 0.8% of the population. People may have a cervical rib on the right, left or both sides.

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16
Q

Which group more commonly develop a cervical rib?

A

Females

17
Q

What is the main complications of a cervical rib?

A

Thoracic outlet syndrome: either compression of the brachial plexus or compression of the subclavian artery.

18
Q

What are the clinical features of thoracic outlet syndrome?

A

Compression of the brachial plexus may be identified by weakness of the muscles around the muscles in the hand, near the base of the thumb.

Compression of the subclavian artery is often diagnosed by finding a positive Adson’s sign on examination, where the radial pulse in the arm is lost during abduction and external rotation of the shoulder.