Neck Lumps

Question 1

Differentials by location:

Anywhere

Answer 1

Lipoma

Sebaceous (epidermoid) cyst. May have central punctum.

Question 2

Differentials by location:

Midline

Answer 2

Thyroid: goitre, colloid nodule, adenoma, cancer, cyst.

Thyroglossal cyst.

Dermoid cyst. Rubbery and feels attached to underlying bone.

Question 3

Differentials by location:

Anterior angle

Answer 3

Lymph node.

Branchial cyst.

Parotid tumour.

Carotid body tumour or carotid artery aneurysm (pulsatile).

Question 4

Differentials by location:

Submandibular triangle sits within the anterior triangle:

Answer 4

• Lymph node.

* Salivary: stone, tumour, sialadenitis.

Question 5

Differentials by location:

Posterior angle

Answer 5

• Cystic hygroma: a congenital lymphangioma, usually on left.

Question 6

Lymphadenopathy

When examining lumps, what makes it almost certain of lymph nodes?

Answer 6

Having more than 1

Question 7

Causes:

Inflammation
Infection
Infiltration

Answer 7

Autoimmune disease

EBV, TB, HIV

Lymphoma
Mets (GI, lung, head and neck)

Question 8

New neck lumps that are suspicious for cancer

Answer 8

Lumps in older patients (>40yrs old)
Lumps in smokers
Painless lumps
Rubbery lumps - lymphoma

Question 9

Investigations

Lump imaging:

What is first line?

What is a doppler US used for?

What bigger imaging can be used?

Answer 9

US

Doppler US for carotid body tumour or aneurysms

CT
MRI

Question 10

Investigations:

Tissue sampling:

What is first line?

How are firm lumps sampled?

How can pharyngeal or laryngeal lumps be sampled?

Answer 10

Firm needle aspiration - usually done during USS

Incisional biopsy or excision biopsy

Biopsied through endoscopy