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Neck lumps
 

Neck lumps

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    Neck lumps Neck lumps Presentation Transcript

    • QUESTIONS 1The mother of a 2-year old becomes concerned after she noticesa lump in his neck. On examination, the child is well, there is aswelling in the subcutaneous tissue of the posterior trianglewhich transilluminates. The most likely diagnosis is:A. Dermoid cystB. Branhial cystC. Thyroglossal cystD. Cystic hygromaE. Ranula
    • QUESTION 2A 61-year old lady presents with a neck lump. The mass is belowthe sternocleimastoid muscle. Although the swelling ispainless, she is profoundly embarrassed by halitosis. Themost likely diagnosis is:A. GoitreB. Reactive lymphadenopathyC. LymphomaD. Pharyngeal pouchE. Cervical rib
    • QUESTION 3A 31- year old man presents with recurrent infection andabscesses in the neck. On examination, you notice a midlinedefect with an overlying scab. The swelling moves upwardson tongue protrusion. The defect is most likely due to:A. Dermoid cystB. Branhial cystC. Thyroglossal cystD. Cystic hygromaE. Ranula
    • QUESTION 4A 80-year old complains of neck swelling after a recentcold, which has not resolved. On direct questioning, he hasexperienced night sweats and has noticed some pain in thelumps when he drinks wine with his meals. Examinationreveals multiple, painless swelling in the neck of a ‘rubbery’consistency. His symptoms are most likely due to:A. GoitreB. Reactive lymphadenopathyC. LymphomaD. Pharyngeal pouchE. Cervical rib
    • QUESTION 5A fit 19-year old man notices a neck swelling whilst he is shaving.On examination, there is a smooth, round and mobile lumpnot tethered to underlying structures. Fluid aspirated from theswelling contains cholesterol crystals. The most likely causeof the swelling is:A. Dermoid cystB. Branhial cystC. Thyroglossal cystD. Cystic hygromaE. Ranula
    • 1. Reactivelymphadenopathy2. Lymphoma3. Dermoid cystMidline lumps:1. Thyroid swelling2. Thyroglossal cyst3. Pharyngeal pouchLateral lumps:6. Cystic hygroma7. Branchial cyst8. Cervical rib9. Carotid aneursymSESSION OVERVIEW
    • A COMMON COMPLIANT…• You will see a lot of neck lumps, whether you work inGP pr hospital.• Affects all age groups.• Comes in all shape, sizes and consistencies.• Painful vs. painless.• Can occur in isolation, or accompany other systemic orlocal symptoms.• A common presentation of head and neckmalignancy, beyond the scope of this presentation.
    • ANATOMY: TRIANGLES OF THE THE NECK
    • ANATOMY: LEVELS OF THE NECK• I:Submental/submandibular triangles.• II: To hyoid bone• III: To omohyoid muscle• IV: To clavicle• V: Posterior triangle• VI: Midline• I and V sometimes sub-divided into a + b.
    • 1. REACTIVE LYMPHADENOPATHY• By far the most common cause of neck swellings.• Affects all age groups.• Tender to touch.• History of local infection or generalised viral illness.• Should resolve spontaneously.• No specific treatment required.
    • 2. LYMPHOMA• Manifestation of a systemic malignancy.• Rubbery, painless lymphadenopathy.• Pain on drinking alcohol, uncommon symptom.• May be associated with night sweats, weight lossand splenomegaly.
    • 3. DERMOID CYST• Can occur anywhere in the body.• Cystic teratoma.• Contains developmentally mature and well-differentiated tissue: clumps of hair, pockets ofsebum, bone, teeth, eyes, cartilage and/or thyroidtissue.• Almost always benign.• Management: Complete surgical removal withoutspillage of contents.
    • 4. THYROID SWELLING• Most likely due to hyperthyroidism or hypothyroidism.• Thyroid disease F > M.• Typically young female patients.• Midline swelling.• Moves upwards on swallowing.• Accompanied by thyroid symptoms: Heatintolerance, palpitations, diarrhoea, fine tremor, proptosis etc.• FNA may be useful to rule-out more sinister pathology• Manage underlying thyroid disorder.
    • 5. THYROGLOSSAL CYST• Fibrous cyst due to persistence of the thyroglossal duct.• More common in patients <20 years age.• Location: Midline, usually between hyoid bone and thyroidisthmus.• Movement: Upwards with tongue protusion.• May be painful if infected.
    • 6. PHARYNGEAL POUCH• Posteromedialherniation between thyropharyngeus andcricophayrgeus muscles.• Most common in older men.• Not usually seen, can be perforated during an OGD.• Can present as a large midline lump in neck.• Gurgles on palpation.• Trapped food debris causes halithosis.• Symptoms:Dysphagia, regurgitation, aspiration, halithosis, chornic cough.
    • 7. CYSTIC HYGROMA• Congential lymphatic lesion (lymphangioma).• Typically found in neck.• Classically on left side.• Most evident at birth.• 90% present by age 2 years.• Management: Surgery
    • 8. BRANCHIAL CYST• Failure of obliteration of 2ndbranchial cleft inembryonic development.• Oval, mobile, cystic mass developing betweenSCM and pharynx.• Usually presents in teenage years and earlyadulthood.• Management: Conservative (no treatment) orsurgical excision.• Management:
    • 9. CERVICAL RIB• Extension of costo-cartilage on 7th cervical vertebra.• Prevalence: 1 in 500 (0.2% population).• More common in adult females.• 10% develop thoracic outlet syndrome.• Also compression of brachial plexus and subclavianartery.• Abson’s sign: Loss of radial pulse on arm abductionand external rotation.
    • 10. CAROTID ANEURSYM• Pathological dilatation of carotid artery.• Secondary to atherosclerotic disease.• Puslatile lateral neck mass, doesn’t move onswallowing.• May hear a bruit.• Rare, incidence increases with age.• Other isk factors: Trauma, HTN, endocarditis.• Management dependent on size: Conservative vs.surgical repair
    • INVESTIGATIONS• Blood tests• FBC• U&Es, CRP• Thyroid function tests• Imaging:• USS• CT• MRI• Biopsy:• Fine needle aspiration (FNA)• Excision biopsy
    • • Look – Listen –Feel• Site• Size• Shape• Surface (Smooth orNodular?)• Mobility (Tethered?)• Consistency• Colour• Tenderness• Transillumination• Consider sex andage group ofpatient.• Timing• Pain• Movement• AssociatedsymptomsSUMMARY: TIPS FOR PHYSICAL EXAMINATION
    • REVIEW: QUESTION 1The mother of a 2-year old becomes concerned after she notices a lump inhis neck. On examination, the child is well, there is a swelling in thesubcutaneous tissue of the posterior triangle which transilluminates.The most likely diagnosis is:A. Dermoid cystB. Branhial cystC. Thyroglossal cystD. Cystic hygromaE. RanulaCorrect answer: D
    • REVIEW: QUESTION 2A 61-year old lady presents with a neck lump. The mass is below thesternocleimastoid muscle. Although the swelling is painless, she isprofoundly embarrassed by halitosis. The most likely diagnosis is:A. GoitreB. Reactive lymphadenopathyC. LymphomaD. Pharyngeal pouchE. Cervical ribCorrect answer: D
    • REVIEW: QUESTION 3A 31- year old man presents with recurrent infection and abscesses in theneck. On examination, you notice a midline defect with an overlyingscab. The swelling moves upwards on tongue protrusion. The defect ismost likely due to:A. Dermoid cystB. Branhial cystC. Thyroglossal cystD. Cystic hygromaE. RanulaCorrect answer: C
    • REVIEW: QUESTION 4A 80-year old complains of neck swellings after a recent cold, which hasnot resolved. On direct questioning, he has experienced night sweatsand has noticed some pain in the lumps when he drinks wine with hismeals. Examination reveals multiple, painless swelling in the neck of a‘rubbery’ consistency. His symptoms are most likely due to:A. GoitreB. Reactive lymphadenopathyC. LymphomaD. Pharyngeal pouchE. Cervical ribCorrect answer: C
    • REVIEW: QUESTION 5A fit 19-year old man notices a neck swelling whilst he is shaving. Onexamination, there is a smooth, round and mobile lump, not tethered tounderlying structures. Fluid aspirated from the swelling containscholesterol crystals. The most likely cause of the swelling is:A. Dermoid cystB. Branhial cystC. Thyroglossal cystD. Cystic hygromaE. RanulaCorrect answer: B
    • ‘ To be a successful surgeon, you need theeyes of a hawk, the heart of a lion andthe hands of a lady…’Sir Lancelot Spratt, Doctor in the House