neck lumps

Question 1

infective causes of neck lump

Answer 1

1. reactive lymphadenopathy - increase in the size of cervical lymph nodes in response to infection
2. lymphoma
3. head and neck cancers

Question 2

vascular causes

Answer 2

carotid body tumor

benign tumor that arises from cells of the carotid body at the bifurcation of common carotid

Question 3

autoimmune cause

Answer 3

thyroid disease - grave’s/hashimoto’s

Question 4

congenital causes

Answer 4

1. cystic hygroma
2. thyroglossal cyst
3. branchial cyst
4. dermoid cyst
5. teratoma

Question 5

what is the first line Ix

Answer 5

1. Ultrasound
2. Fine needle aspiration
3. if lymphoma is suspected than core biospy or open excision lymph node biopsy will be preferred over FNA

Question 6

cystic hygroma

Answer 6

1. benign fluid filled sac caused by malformation of the lymphatic system
   i. diagnosed < 2 years
2. soft painless fluctuant lump that transilluminates
3. Tx - surgical excision

Question 7

carotid body tumors

Answer 7

1. benign neuroendocrine tumors from the paraganglion cells of the carotid body
2. pulsatile painless neck lump with bruit
3. may compress cranial nerves

Question 8

mx of carotid body tumors

Answer 8

1. conservative management

2. surgical exciision / radiotherpay

Question 9

thyroglossal cyst

Answer 9

1. congenital fluid filled sac

2. painless midline mass which moves up with the protrusion of the tongue

Question 10

Mx of thyroglossal cyst

Answer 10

surgical intervention - sistrunk procedure

Question 11

Branchial cyst

Answer 11

1. congenital mass
2. lateral aspect of the neck, anterior to the sternocleidomastoid

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx

3. may cause dysphagia/dysphonia and difficulty breathing

Question 12

Mx of branchial cysts

Answer 12

surgical excision

common differential is a cystic met from squamous clell carinoma of the head and neck

Question 13

Pharyngeal pouch

Answer 13

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough