Neck lumps Flashcards
(36 cards)
Characteristics of a lump
4S: Site, size, shape, sound
4T: Temperature, tenderness, transillumination, tethering/mobility
4C: Contour, consistency, colour, compression
Borders of the anterior triangle of the neck
Midline, mandible, sternocleidomastoid
Borders of the posterior triangle of the neck
Sternocleidomastoid, clavicle, anterior margin of the trapezius
Lymph node compartments/levels of the neck
DDx of pulsatile masses in the anterior triangle
Carotid body tumour
Carotid artery aneurysm
DDx of non-pulsatile masses in anterior triangle
Midline:
- Thyroglossal cyst (moves upwards with tongue)
- Dermoid cyst (non-mobile)
- Chondroma
Non-midline:
- Goitre (may be retrosternal, may be uni/multinodular, may have bruits)
- Branchial cyst
- Laryngeocoele
- Pharyngeal pouch
- Lymphadenopathy
DDx of posterior triangle masses
Malignancy until proven otherwise!
Reactive lymphadenopathy
Pharyngeal pouch
Lymphoma
Cervical rib
Cystic hygroma
Subclavian aneurysm
Pancoast’s tumour
Features of hyperthyroidism
Sweating
Weight loss/weakness (proximal myopathy)
Emotional lability
Appetite increased
Tremor/tachycardia
Irritability, irregular mensturation, intolerance of heat
Nodules/goitre
GI problems (diarrhoea)
Common causes of hyperthyroidism (overactive thyroid gland)
Graves’ (autoimmune)
Toxic multinodular goitre/solitary adenoma
Amiodarone (high I2 content)
High beta-HCG (pregnancy, hydratiform mole)
Pituitary adenoma
Follicular thyroid cancer
Causes of thyrotoxicosis (not necessarily overactive thyroid gland, detected by reduced I2 uptake)
Hyperthyroidism
De Quervain’s thyroiditis (followed by hypothyroidism, self-limiting)
Supre-therapeutic Levothyroxine
Features of Graves’ disease
Lid lag
Exophthalmos
Chemosis
Bruits
Smooth uniform goitre
Reduced eye movements
Features of hypothyroidism
- Symptoms
- Weight gain
- Low mood
- Tiredness
- Amennorhea/menstrual distrubances
- Cold sensitivity
- Hoarseness
- Memory impairment
- Signs
- Bradycardia
- dry skin
- Hair loss (outer 1/3 of eyebrows)
- Coarse facial features
- Malar flush
- Painless goitre
Causes of hypothyroidism
Autoimmune: Hashimoto’s (most common!)
Iatrogenic: Radiation, drugs (amiodarone, lithium, carbimazole)
Other: Iodine deficiency, post-partum, congenital
DDx of parotid lump
Parotitis
Salivary gland tumour
Stone
DDx of lateral neck lump
Artery: Carotid aneurysm, carotid body tumour, subclavian aneurysm
Lymph nodes: Infective, malignant, granulomatous
Nerve: Neurofibroma, schwannoma
Larynx: Laryngocoele
Pharynx: Pharyngeal pouch
Branchial: Cyst/sinus/fistula
Skin: Lipoma, epidermal cyst, abscess
Musculoskeletal: Cervical rib, sarcoma
Most common causes of neck lumps in children
75% benign causes (congenital malformations, inflammatory lymphadenitis)
Most common causes of neck lumps in adults
75% malignant (80% mets, 20% lymphomas)
Painful neck lumps
Infective lymphadenitis
Infected branchial cyst
How does duration of neck lump presence change differential?
<few weeks:> Infective/inflammatory lymphadenopathy (NB: may be ‘suddenly’ notice by patient)</few>
>few weeks: Must exclude malignancy
Years: Benign most likely
DDx if lumps present elsewhere
Disseminated malignancy (e.g. lymphoma)
Systemic disease (e.g. EBV, HIV)
Hx questions for neck lumps
Recent infection/contact with infected person
Symptoms of head/neck cancer: Voice/swallowing changes, inspiratory noises/difficulty breathing, hearing loss/otalgia
Radiotherapy of neck
Smoking/alcohol intake
DDx of superficial neck lumps
Lipomas, abscesses, epidermal/dermoid cysts
Associated symptoms of pharyngeal pouch
halitosis, dysphagia, gurgling on palpation, chronic cough
How to examine relationship of lump to muscle
Ask pt to nod head against resistance (SCM) or shrug shoulder against resistance (trapezius)
Deep to muscle –> concealed
