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Last AM Report Ever

Danielle Smith, MD, MPH June 10, 2011

Neck masses
Inflammatory Congenital Neoplastic Trauma

Inflammatory


Infectious
Reactive viral LAD
 

Adenovirus, rhinovirus, enterovirus EBV, CMV, HIV (45%) MSSA, MRSA, GAS Tularemia, Brucellosis, Bartonella Actinomyces, Toxoplasma, Mycobacteria (scrofula)

Bacterial/Parasitic
  

Deep neck space infx, Ludwigs angina




Noninfectious
Sarcoidosis, Castleman, Kawasaki, drugs, CGD, Lupus, SS

Congenital
 

Branchial cleft cyst---ant to SCM cyst---ant Thyroglossal duct cyst---midline mass, asympt until cyst---midline infx w/URI Vascular
Tumors Malformations

  

Teratoma Dermoid cyst Cystic hygroma

Neoplastic
   

239 LN bx: 13% Hodgkins lymphoma--80% lymphoma--80% Supraclavicular LAD=75% risk nHL, neuroblastoma, rhadomyosarcoma, ALL, AML Lipomas, Schwannomas, Paragangliomas

Traumatic


Subcut emphysema=tracheal/pulmonary injury Hematoma

Important H&P Points


Age, duration (acute, subacute/chronic) Travel history, exposure to animals Neck pain, hoarseness, stridor, dysphagia=BAD Fever, night sweats, fatigue, wt loss=BAD Neck ROM, palpation, size, consistency, mobility and location; unilateral/bilateral, tenderness, warmth, redness Generalized vs. localized LAD Supraclavicular LAD, hard, >3cm, nonmobile=BAD