ENT_ NECK LUMPS

Reactive Lymphodenopathy

By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness

Thyroid Swelling

May be hypo-, eu- or hyperthyroid symptomatically Moves upwards on swallowing

Causes of neck Lumps

Reactive Lymphadenopathy Lymphoma Thyroid swelling Thyroglossal Cyst Pharyngeal pouch Cystic Hygroma Branchial Cyst Cervical Rib Carotid Anurysm Epidermoid Cyst Deep Cervical Abscess

Congenital

branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation

Differential diagnosis of a neck lump in children:

congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation inflammatory: reactive lymphadenopathy, lymphadenitis, neoplastic: lymphoma, thyroid tumour, salivary gland tumour

Ix of neck lump

consider and exclude other malignancy ultrasound referral to ENT fine-needle aspiration

Neoplastic

lymphoma, thyroid tumour, salivary gland tumour

Inflammatory

reactive lymphadenopathy, lymphadenitis,

Cystic Hygroma

• A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side • Most are evident at birth, around 90% present before 2 years of age Associated with turner's Cystic hygromas are congenital lymphatic lesions that are typically found in the neck and axilla region with a predilection for the left side. The majority present by 2 years of age. On physical examination, cystic hygromas are often soft, painless and transilluminate brightly.

brachial cyst

• An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx • Develop due to failure of obliteration of the second branchial cleft in embryonic development • Usually present in early adulthood A branchial cyst is a benign, developmental defect of the branchial arches. The cyst is filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium. Branchial cysts may have a fistula and are therefore prone to infection. They may enlarge following a respiratory tract infection. They typically present in late childhood or early adulthood and present as asymptomatic neck lateral neck lumps and are usually located anterior to the sternocleidomastoid muscle. There is a slight male predisposition and account for around 20% of paediatric neck masses.

Deep Cervical Abscess

• Deep cervical abscesses typically occur following a source of infection such as recent dental work, upper respiratory tract infections, neck or oral cavity trauma. They can occur at any age. On physical examination, the patient typically presents with a painful and tender swelling that may be hot to touch. The patient may also have other signs of infection such as fever, chills, aches, and pains.

Epidermoid cyst

• Epidermoid cysts are common cutaneous cysts that result from the proliferation of epidermal cells within a circumscribed space of the dermis. • They can occur at any age and are typically asymptomatic. • On physical examination they are typically firm, round nodules of various sizes and a central punctum may be present.

2ww of H&N cancer referral

• Hoarseness persisting for more than six weeks. • Oral swellings persisting for more than three weeks. • Dysphagia persisting for more than three weeks. • Unilateral nasal obstruction, particularly when associated with purulent discharge. • Unresolving neck masses for more than three weeks. • Cranial neuropathies. Orbital masses.

Cervical rib

• More common in adult females • Around 10% develop thoracic outlet syndrome

Pharyngeal Pouch

• 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

thyroglossal Cyst

• More common in patients < 20 years old • Usually midline, between the isthmus of the thyroid and the hyoid bone • Moves upwards with protrusion of the tongue May be painful if infected

Carotid aneurysm

• Pulsatile lateral neck mass which doesn't move on swallowing

Lymphoma

• Rubbery, painless lymphadenopathy • The phenomenon of pain whilst drinking alcohol is very uncommon There may be associated night sweats and splenomegaly