Neck Masses and Lymph Nodes

Question 1

How are thyroglossal duct cysts formed?

Answer 1

When the thyroglossal duct tract persists and fails to close

Question 2

Where are thyroglossal duct cysts located?

Answer 2

MIDLINE anywhere from the base of the tongue to the thyroid isthmus

Question 3

CP of thyroglossal duct cysts?

Answer 3

1. Usually found prior to age 10
2. Painful
3. Palpable
4. Dysphagia

Question 4

Where do thyroglossal duct cysts occur in relation to strap muscles?

Answer 4

Medial to strap muscles

Question 5

SF of thyroglossal duct cyst?

Answer 5

1. Midline cystic structure
2. Anechoic or complex
3. Typically <3cm

Question 6

Where does the branchial cleft extend from?

Answer 6

Pharyngeal cavity to an opening near the auricle or neck

Question 7

What 3 abnormalities may form from a branchial cleft?

Answer 7

1. Cysts
2. Sinuses
3. Fistulas

Question 8

Are branchial cleft cysts usually singular or multiple and unilateral or bilateral?

Answer 8

Singular and unilateral

Question 9

Which branchial cleft cyst is most common?

Answer 9

2nd type: upper/anterior or adjacent to SCM muscle

Question 10

Where are the 1st branchial cleft cysts located?

Answer 10

Type 1: Auditory canal
Type 2: Submandibular area

Question 11

Where are the 2nd branchial cleft cysts located?

Answer 11

Are the most common type and located upper/anterior or adjacent to SCM muscle

Question 12

Where are the 3rd branchial cleft cysts located?

Answer 12

Rare and located DEEP to the SCM

Question 13

Where are the 4th branchial cleft cysts located?

Answer 13

Rare and variable location

Question 14

Branchial cleft cysts are considered where in the neck?

Answer 14

Lateral neck masses

Question 15

CP of branchial cleft cysts?

Answer 15

1. Palpable neck masses
2. Tender with infection

Question 16

SF of branchial cleft cysts?

Answer 16

VARIABLE:
1. Anechoic (most common)
2. Homogenous
3. Heterogrenous
4. Hypoechoic
5. Pseudosolid

Question 17

What does pseudosolid mean?

Answer 17

A structure on ultrasound that appears solid but is actually cystic and contains fluid

Question 18

What is the most common appearance of branchial cleft cyst?

Answer 18

Anechoic

Question 19

What abnormality results from a developmental error in the cervical lymphatic system?

Answer 19

Cystic hygroma

Question 20

Cystic hygroma’s have a strong association with which chromosomal abnormalities?

Answer 20

1. Trisomy 21
2. Trisomy 18
3. Turner syndrome

Question 21

Most common cause of deep neck space infections in both adults and children?

Answer 21

Adults: Dental issues/infections

Children: Tonsilitis

Question 22

What are the three most common spaces for abscesses?

Answer 22

1. Submandibular
2. Retropharyngeal
3. Parapharyngeal

Question 23

Patient presents with pain, difficulty swallowing, and has recently had dental work done, what is the most likely diagnosis?

Answer 23

Deep neck space infection

Question 24

What is the gold standard to evaluate deep neck space infections?

Answer 24

CT

Question 25

Describe phlegmon vs. abscess?

Answer 25

Phlegmon = UNCONTAINED area of inflammation and can spread to adjacent structures Abscess = walled off collection of puss and is confined to an area. Usually contains thickened walls

Question 26

What is most likely to spread to nearby structures: abscess or phlegmon?

Answer 26

Phlegmon because it is uncontained

Question 27

In what population are lymph nodes harder to see?

Answer 27

Older

Question 28

What is the normal appearance of a lymph node?

Answer 28

1. Round or oval 2. Hypoechoic 3. Hilar vascularity 4. echogenic fatty hilum 5. Generally about 1cm in size AP

Question 29

SF of an abnormal lymph node?

Answer 29

1. Round 2. Hypoechoic 3. Cystic necrosis within 4. Chaotic vascularity 5. Increased size 6. Absence of fatty hilum

Question 30

What does cystic necrosis mean?

Answer 30

An area of dead tissue that has undergone liquefaction and results in a cystic appearance

Question 31

Appearance of a lymph node as a result of metastases from papillary thyroid carcinoma?

Answer 31

1. Hyperechoic lymph nodes 2. Calcifications within

Question 32

What is the largest lymph node in the body?

Answer 32

Jugulodigastric

Question 33

Most common causes for lymphadenopathy? (hint: 3)

Answer 33

1. Autoimmune 2. Infection 3. Neoplastic