Neck swelling , Syed Alam Zeb

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Neck swelling , Syed Alam Zeb

  1. 1. NECK SWELLING Dr.Syed Alam Zeb
  2. 2. DIFFERENTIAL DIAGNOSIS <ul><li>ENLARGED LYMPH NODES: Due to, Bacterial, Viral infections. Tuberculosis. Leukemias, Lymphomas or mets. from tumours. </li></ul>
  3. 3. <ul><li>SWELLING IN THE ANGLE OF THE JAW: May be due to, </li></ul><ul><li>Enlarged jugalodiagastric lymph nodes. </li></ul><ul><li>Cystic Hygromas in children. </li></ul><ul><li>Enlarged submandibular or parotid gland. </li></ul><ul><li>Carotid body tumour. </li></ul>
  4. 4. <ul><li>MIDLINE SWELLINGS: </li></ul><ul><li>Ludwigs angina. </li></ul><ul><li>Enlarged submental lymph nodes. </li></ul><ul><li>Thyroglossal cysts. </li></ul><ul><li>Thyroid enlargement. </li></ul><ul><li>Thymic enlargement. </li></ul>
  5. 5. <ul><li>LATERAL SWELLINGS: </li></ul><ul><li>Lymph nodes. </li></ul><ul><li>Collar stud’s absceses. </li></ul><ul><li>Branchial Cysts. </li></ul><ul><li>Thyroid swelling. </li></ul><ul><li>Pharyngeal pouch. </li></ul><ul><li>Laryngocele. </li></ul>
  6. 6. <ul><li>Lipomas, Neurofibromas, Haemangiomas, Dermoid and Sebacious cysts can occur any where in the neck area. </li></ul>
  7. 7. CYSTIC HYGROMA IN A CHILD
  8. 8. COLLAR STUD’S ABSCESS
  9. 9. PAROTID TUMOUR
  10. 10. THYROGLOSSAL CYST
  11. 11. THYROID ENLARGEMENT
  12. 12. MANAGEMENT <ul><li>Take detail history. </li></ul><ul><li>Thorough examination of head and neck area. </li></ul><ul><li>Determine the nature of swelling. </li></ul><ul><li>Investigate accordingly. </li></ul><ul><li>Consider biopsy, FNAC or excision. </li></ul><ul><li>Definite treatment depends on the nature of swelling. </li></ul>
  13. 13. THYROID ENLARGEMENT <ul><li>CAUSES OF THYROID ENLARGEMENT: </li></ul><ul><li>1 .Multinodular goiter due to iodine deficiency. </li></ul><ul><li>2.Single nodule which may be a dominant nodule in MNG.,tumor, or cyst. </li></ul><ul><li>3.Generalized enlargement like toxic goiter in grave’s disease, nontoxic goiter of puberty. </li></ul>
  14. 14. <ul><li>4. Thyroid tumors: Papillary ca, Follicular ca, Ana plastic ca, Medullary ca, Lymphomas or secondary tumors. </li></ul><ul><li>5.Thyroiditis like Hashimoto’s disease and Riedels thyroiditis. </li></ul>
  15. 15. MANAGEMENT OF THYROID NODULE <ul><li>History. </li></ul><ul><li>Examination. </li></ul><ul><li>Ultrasound neck. </li></ul><ul><li>FNAC. </li></ul><ul><li>TFTs, T3,T4 and TSH. </li></ul><ul><li>Thyroid scan. </li></ul><ul><li>Bone scan, chest x-ray and liver us in tumors. </li></ul>
  16. 16. TOXIC GOITER <ul><li>Caused either by graves’ disease or toxic adenoma. </li></ul><ul><li>Clinical features include palpitations, sweating, loss of weight and increased appetite. Patient looks nervous, has tremors, palm sweating, increased pulse rate and protruding eyes..exophthalmoses. </li></ul>
  17. 17. Toxic goiter cont: <ul><li>Investigations show a rise in T3 ,T4 and fall in TSH. </li></ul><ul><li>Thyroid scan will show either a hot nodule or generalized enlargement with increased uptake. </li></ul><ul><li>Initially patient is treated with beta blockers and antithyroid drugs. </li></ul><ul><li>Surgery considered when patient is euthyroid </li></ul>
  18. 18. SURGERY FOR GOITER <ul><li>MNG and Graves disease: Subtotal thyroidectomy. </li></ul><ul><li>Toxic nodule/ malignant nodule: Thyroid lobectomy .. </li></ul><ul><li>In malignant cases total thyroidectomy is sometimes performed . </li></ul>
  19. 19. POST-OPERATIVE COMPLICATIONS <ul><li>Hemorrhage. </li></ul><ul><li>Haematoma formation. </li></ul><ul><li>Recurrent laryngeal nerve damage. </li></ul><ul><li>Hypothyroidism. </li></ul><ul><li>Hypocalcaemia. </li></ul><ul><li>Keloid scar formation. </li></ul><ul><li>Tracheomalacia. </li></ul>
  20. 20. HYPERPARATHRODISM <ul><li>CAUSES: </li></ul><ul><li>Hyper secretion of parathyroid hormone either due to Adenoma of one of the four parathyroid glands or due to hyperplasia of all the four glands. </li></ul>
  21. 21. <ul><li>PRIMARY HYPERPARATHYRODISM: When the glands are producing increased amounts of PTH. </li></ul><ul><li>SECONDARY HYPERTHYRODISM: When there is demand for increased amounts of PTH.as in chronic renal failure. </li></ul><ul><li>TERTIARY HYPERTHYRODISM: Initially there is demand for increased amounts, but later on the glands become autonomous without demand. </li></ul>
  22. 22. <ul><li>PTH regulates the serum Calcium levels. </li></ul><ul><li>In hyperparathyroidism the serum calcium levels are high. </li></ul><ul><li>PTH acts on the bones and mobilizes the calcium from there. </li></ul><ul><li>Bones become very weak, prone to fractures. </li></ul>
  23. 23. CLINICAL FEATURES <ul><li>50% patients are asymptomatic. </li></ul><ul><li>Majority present with dyspeptic symptoms. </li></ul><ul><li>Some present with bone pains and spontaneous fractures. </li></ul><ul><li>Kidney stone formation very common in these patients. </li></ul><ul><li>Few patients have psychiatric problems. </li></ul>
  24. 24. INVESTIGATIONS <ul><li>Tests for the confirmation/ diagnosis of the disease. </li></ul><ul><li>Tests for the localization of hyper functioning parathyroid gland. </li></ul>
  25. 25. TESTS FOR THE DIAGNOSIS <ul><li>Serum calcium, usually elevated. </li></ul><ul><li>24 hrs urinary calcium is raised. </li></ul><ul><li>Serum phosphate is low. </li></ul><ul><li>Serum alkaline phosphatse is raised. </li></ul><ul><li>Serum PTH levels are elevated. </li></ul><ul><li>Skeletal survey for bone changes. </li></ul>
  26. 26. TESTS FOR LOCALIZATION <ul><li>Ultrasound neck. </li></ul><ul><li>MRI. </li></ul><ul><li>Isotope scans. </li></ul><ul><li>Selective venous sampling. </li></ul>
  27. 27. X-ray in hyperparathyroidism <ul><li>Resorption of the terminal phalyngeal bones is typical. </li></ul>
  28. 28. <ul><li>Osteitis fibrosa cystica. Multiple cysts are formed in the bones. </li></ul>
  29. 29. ISOTOPE SCANS <ul><li>CYSTA-MIBI scan showing a parathyroid adenoma. </li></ul><ul><li>Thallium-technetium subtraction scan is also useful. </li></ul>
  30. 30. TREATMENT <ul><li>If there is adenoma of the gland, excise that particular gland. </li></ul><ul><li>If there is hyperplasia of all the four glands, excise all the four, but reimplant some parathyroid tissue in to the sternomastoid muscle. </li></ul>

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