- A 40-year-old female presented with a gradually enlarging midline neck swelling over the past year without symptoms of thyroid dysfunction. - On examination, a 3cm x 4cm solitary, smooth, mobile swelling was found in the lower midline neck extending to the right sternocleidomastoid. - Differential diagnoses included benign thyroid nodule, colloid goiter, follicular adenoma, or cyst. Tests planned included bloodwork, thyroid function tests, ultrasound of the neck, and FNAC of the neck swelling.

1. CASE
PRESENTATION
Dr. AZAD MEENA
JRA 2ND Yr

2. Case presentation
• Name – Manju devi
• Age – 40year
• Sex – female
• Religion - hindu
• Occupation – housewife
• Residence – motihari, patna
• D/O PRESENTATION 22 sept 2020
• D/o examination – 04 OCT 2020

3. • Chief complain –
midline neck swelling since 1 year
fever on/off since 1 year
pain on/off since 1 year

4. History of present illness
• Patient was apparently well 1 year back when
she noticed midline neck swelling more on
right side aroud 1cm x 1cm. Which was
insidious in onset progressively increasing in
size to the present size of around 3cm x 4cm .
Patient also have complain of low grade
fever(3-4times) and pain which was relieved
by medication but swelling was gradually
increasing in size.

5. • No h/o rapid increase in size
• No h/o difficulty in swallowing and change in voice
• No h/o hemoptysis / hematemesis/jaundice
• No h/o loss of weight and gain of weight
• No h/o hot/cold intolerance
• No h/o irritability/insomnia/excitability/tremer
• No h/o palpitation
• No h/o bowel and bladder disturbance
• No h/o protrusion of eye
• No h/o any other swelling in the neck and body
• No h/o appetite loss
• no h/o TB/ contact with TB patient

6. PAST HISTORY
• Pt. Have history of hysterectomy 3 year back
in a private hospital with the c/o heavy vaginal
bleeding since 2 yr.(documents not available)
• No h/o any medication
• No h/o similar complains in the past
• No h/o radiation exposure

7. FAMILY HISTORY
• No h/o similar illness in family
• No h/o any malignancy
• No h/o DM/ASTHMA/TB/HTN

8. Obstetric and Menstrual history
• Pt is married and mother of four child
• LMP- 3 yr back before hysterectomy
• No h/o abortion
• Now amenorrhic since 3yrs

9. Personal history
• Pt is on mixed diet
• Appetite is normal
• Sleep is normal
• Bowel and bladder habits normal
• Not addicted to any substance

10. summary
• A 40 yr female presented with swelling in the
midline neck, gradually increasing in size over
past 1 year without symptoms of
hypothyroidism /hyperthyroidism and no local
pressure symptoms

11. General physical examination
• Pt is cooperative concious and well oriented to time ,
place and person
• Examination done in sitting position
• Moderately built
• She is well hydrated and moderately nourished
• Vital :-
Blood pressure – 130/80mmHg in right arm in supine
position
Pulse rate - 80bpm regular, normal volume and
character.
Respiratory rate – 16/min abdominothorasic type
Temperature - ???

12. • No pallar, icterus, clubbing, pedal oedema,
palpable lymph node and cynosis

13. Local Examination
• Pt was examined in sitting position with verbal
consent of patient in the presence of
attendant.

14. On Inspection
• Inspection is done by following Pizillo`s method.
• A single spherical swelling seen in lower midline
neck more on right side looks around 3cm x 4cm in
size. It moves with deglutition. Edge of swelling is
indistinct.
• Non pulsatile.
• Moves with tongue protrusion.
• No distended vein seen over swelling.
• The Lower border is visible on deglutition.
• skin over swelling apears normal

15. On Palpation
• The swelling is palpated from behind with the neck
slightly flexed
• There is no local rise in temperature
• No tenderness
• A single swelling is palpable in the midline 3cm x 4cm
in size.
• Extend behind the anterior border of
sternocleidomastoid on right side
• Smooth surface.
• Well defined margin.
• Uniform and soft consistency
• Swelling is movable in both horizontal and vertical
direction.

16. • Normal position of trachea.
• Translucency negative
• no impulse on coughing
• Nonreducible
• Overlying skin is movable
• Dissapear on contraction of sternocleidomastoid
muscle
• cervical lymph node is not palpable.

17. Percussion
• Not done
• Auscultation
• No bruit heard

18. Systemic examination
• CVS-S1S2 Heard, no added murmur
• RS – B/L chest expansion equal with B/L
normal vesicular breath sounds. No added
sound
• P/A – soft, no distension, no evidence of
organomegaly or free fluid, bowel sound
present

19. Provisional diagnosis
• Right side nontoxic benign thyroid nodule
• Differential diagnosis
• Colloidal goitre
• Nontoxic Solitory nodule
• Follicular adenoma
• Enlarged Pre tracheal lymph node
• Thyroglossal cyst
• Simple/haemorrhagic cyst
Benign neoplasm

20. PLAN
1. Routine blood investigation
2. Thyroid function test
3. Ultrasound neck
4. FNAC neck