#Lymph node back of neck serial

Therefore, it is essential to examine all of these areas to rule out any sinister causes. previous radiotherapy)Īny lump in the neck can be metastatic lymphadenopathy secondary to malignancy in the nasopharynx, oropharynx, hypopharynx and the oral cavity.

Relevant past medical history - smoking status, alcohol intake, previous head and neck cancers, and known radiation exposure (e.g.

Associated symptoms (especially red flag symptoms, discussed below).

Any recent change in size, number of neck lumps.

The first step in the assessment of a patient with a neck lump is to take a detailed history and perform a comprehensive examination. In this article, we shall discuss the differential diagnoses, investigations, and management of a patient presenting with a neck lump. As such, comprehensive history and examination is required, before considering appropriate investigations. Neck lumps are a common presentation in the general population and have a number of possible causes. As such, an ultrasound-guided FNA is an important investigation prior to arranging for excision of the mass. Sclerotherapy can be offered as an alternative to surgery in certain cases, involving injection of a sclerosing agent under ultrasound guidance.Ĭare needs to be taken when managing these patients as a common differential diagnosis is a cystic metastasis from a squamous cell carcinoma of the head and neck region (especially in the adult population). Surgical excision is the definitive treatment. Larger branchial cysts can result in dysphagia, dysphonia, and difficulty breathing. When infected, they can increase in size and become painful. They present as palpable masses anterior to SCM, typically unilateral (Fig. Incomplete obliteration of these clefts will result in the formation of branchial cysts.

*In rare cases (~1%), patients may develop thyroglossal duct cyst carcinoma that often arises from ectopic thyroid tissue in the cyst (the most common histology is papillary carcinoma)īranchial cysts are congenital masses which arise in the lateral aspect of the neck, typically anterior to the sternocleidomastoid (SCM).ĭuring the fourth week of development, branchial clefts form ridges known as branchial arches, involved in the formation of a number of structures in the head and neck. It is essential that these patients have an ultrasound scan of the neck to identify the thyroid gland pre-operatively, as the only functioning thyroid tissue may be attached to the cyst and risks getting excised during the procedure.

There is a high chance of recurrence if the medial portion of the hyoid bone is not removed. The central body of the hyoid bone is removed to allow complete removal of the entire thyroglossal tract. Standard treatment is surgical intervention, with the modified Sistrunk procedure being the most widely used. 5A) that move up with swallowing and protrusion of the tongue. Thyroglossal cysts present as a palpable painless midline mass* (Fig. In normal development, this duct will obliterate, however thyroglossal cysts occur when portions of this duct remain patent, creating cavities that may fill with fluid and being prone to infection. *Classically carotid body tumours can be moved from side to side but not up and down, due to their location in the carotid sheath, termed Fontaine’s signĭuring embryonic development, the thyroid gland originates from the base of the tongue (foramen caecum), migrating down to its final position in the neck and connecting back to the tongue via the thyroglossal duct. Radiotherapy may be an option for tumours that are unresectable, to limit tumour growth.

#Lymph node back of neck serial

Rarely, patients can present in cardiac arrhythmia if the carotid sinus is stimulated by compression from the tumour.Ĭarotid body tumours can be managed conservatively with active monitoring via serial imaging, or require surgical excision in a specialised unit with both ENT and vascular input. Carotid paragangliomas are slow growing, but can become large enough to compress surrounding cranial nerves, leading to palsies. 4).Ī carotid body tumour will present as a pulsatile painless neck lump, often with a bruit present on auscultation*. The carotid body is made up of a cluster of neuroendocrine cells, whereby sporadic (or hereditary) mutations lead to the formation of paragangliomas (Fig. Carotid body tumours (also known as a carotid paragangliomas) are benign neuroendocrine tumours that arise from the paraganglion cells of the carotid body.