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Lateral Neck Swelling

Lateral Neck Swelling

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Eman AlSaad 207002219

Contents :
Anatomy Definition of lateral neck swelling Pediatric lateral neck swelling : Lateral neck swelling in adult : Differential diagnoses of lateral

neck masses Clinical Approach to lateral neck mass

mastoid and superior nuchal line superiorly and the clavicle inferiorly .Hints on surface Anatomy Anatomically the neck is the area between the lower border of mandible.

. Cricoid cartilage. 3. Thyroid cartilage. 4. 5. hyoid bone.Hints on surface Anatomy The prominent landmarks of the neck are : 1. Sternocleidomastoid muscles. Trachea. 2.



.Hints on surface Anatomy The SCM divides each side of the neck into two major triangles. anterior and posterior .

The lower border of the mandible superiorly . The midline medially.Hints on surface Anatomy The anterior triangle is delineated by : 1. The anterior border of the SCM laterally. 3. 2.

HI .

The posterior border of the SCM anteriorly.Hints on surface Anatomy : The borders of the posterior triangles are : 1. The anterior border of the trapezius muscle posteriorly . The clavicle inferiorly. 3. 2.

Hints on surface Anatomy : The thyroid gland .  Submandibular glands .  Lymph nodes . The parotid glands . .


Neck mass : The general definition of a neck mass is any abnormal enlargement. or growth from the level of the base of skull to the clavicles . swelling.



Lateral Neck mass : The lateral neck swellings are defined with their relation to one constant landmark in the lateral neck – the Sternomastoid muscle and are distributed in the various anatomical triangles .


Lateral Neck lumps in children are common but rarely malignant.  In adults on the other hand. frequently representing reactive lymph node enlargement.Clinical Approach to Lateral Neck mass : History and physical examination are fundamental to making an early and correct diagnosis. benign reactive lymph node enlargement is .

An asymptomatic solitary neck mass in the lateral aspect of the neck in an adult should be considered a metastatic lymph node until proved otherwise. .

Pediatric lateral neck swelling : .

Pediatric lateral neck swelling :
Children commonly present with a short

history of tender, enlarged lymph nodes in the jugulodigastric area (tonsillar lymph node) suggesting an infective process, or multiple small non-tender nodes in the posterior triangle, suggesting a subclinical viral infection.

Pediatric lateral neck swelling :
Cystic swellings are usually congenital and

lymphangioma (cystic hygroma) or haemangioma.
can be due to

lymphangioma (cystic hygroma) :

The isolated jugular lymph sac tends to progress and may assume massive proportions even extending into the axilla .lymphangioma (cystic hygroma) : This congenital anomaly arises from the absence of development of union between jugular lymph sacs and other lymphatics. but is classically found in the left posterior triangle of the neck . multiloculated lymphatic lesion that can arise anywhere.

lymphangioma (cystic hygroma) : Symptoms : A common symptom is a neck mass found at birth. . Signs in physical examination : This cystic swelling is transilluminant and is filled with clear lymphatic fluid. or discovered later in an infant after an upper respiratory tract infection.  It gets recurrently infected because of its lymphoid content.


making this impossible. However. .lymphangioma (cystic hygroma) : Treatment : Treatment involves complete excision of the abnormal tissue whenever possible. cystic hygromas can often invade other neck structures.

Lateral neck swelling in adult : More than 75% of lateral neck masses in patients older than 40 years are caused by malignant tumours. and the incidence of neoplastic cervical adenopathy continues to increase with age. .

moderately movable cystic mass that develops under the skin in the neck between the sternocleidomastoid muscle and the pharynx.Developmental : brancial cleft cyst : is an oval.  . Branchial cleft cysts are remnants of embryonic development and result from a failure of obliteration of the branchial cleft .

brancial cleft cyst : Symptoms Most branchial cleft cysts are asymptomatic. or surgical excision. Treatment  Conservative (i.e. no treatment). but they may become infected . .


Infectious : Abscess – staph / strep / polymicrobial  Tx: abx +/. rule out HIV Tx: Anti-TB meds Cat scratch fever – Bartonella henselae    Single enlarged node Weeks to months after exposure Self limited Mono – get EBV titer  p/w cervical adenopathy . usu.drainage TB – single large node. painless. cervical   Workup: PPD.

TRUMATIC : Rarely produce a solitary mass History Hematoma (s ) .

Tumors Benign Tx: surgical excision Examples: Lipoma Hemangioma Neuroma Fibroma Carotid body tumor Sternomastoid Tumour .

potato like lump in line with the Carotid vessels at the upper border of Thyroid cartilage. MRI and DSA are used to establish a diagnosis. and Carotid Aneurysm.Carotid Body Tumour: An uncommon tumour of the chemoreceptors within the Carotid Body. . nerve sheath tumour. firm. painless. Carotid Angiography. Treatment is careful dissection and excision. it presents in mid life as an ovoid.  It has to be differentiated from a lymph node deposit.


Tumor : Malignant Primary Salivary gland cancer (near ear or angle of mandible)  Lymphoma (lateral neck ) > HODGKIN diseases  SCC  Secondary  metastates .

R-S cells alone are not sufficient for the diagnosis . The malignant cell is the Reed-Sternberg cell. Reed-Sternberg (R-S) cells are essential to the diagnosis of Hodgkin lymphoma. The presence of R-S cells is necessary. but as R-S cells are not unique to HD. .Hodgkin's lymphoma :  Hodgkin lymphoma is a neoplastic proliferation of lymphoid cells predominantly involving lymphoid tissues.

RS : The ReedSternberg cell is a lymphoid cell and in most cases. R-S cells are very large with abundant pale cytoplasm and two or more oval lobulated nuclei containing large nucleoli . and clonal. is a B cell.

TREATMENT ? .Hodgkin's lymphoma : is characterized by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease Patients with a history of infectious mononucleosis due to Epstein-Barr virus may have an increased risk of HL.

Location of metastases : Supraclavicular – check for chest malignancy Virchow’s node – left supraclavicular area .

foreign body reactionNeoplastic: lymphoma. metastasis . blastomycosis. haemangioma. laryngocoele Skin and subcutaneous tissues: sebaceous cyst. tuberculosis. cat scratch. HIVBacterial: staphylococcus. leishmaniasisFungal: histoplasmosis. lipoma Lymph nodes: Infective:Viral: Epstein-Barr virus.Differential diagnoses of lateral neck masses Developmental: branchial cyst. brucellaProtozoa: toxoplasma. coccidiomycosisGranulomatous: sarcoid.

sialolithiasisAutoimmune: Sjögren's syndromeNeoplasticMiscellaneous: AIDS related disease . vagal or sympathetic neuroma Salivary gland (parotid or submandibular)Infective: sialadenitis.Differential diagnoses of lateral neck masses Carotid sheath: aneurysm. carotid body tumour.


2. Investigation . Physical examination . . 4. History . 3.Clinical Approach 1. management .

the first concern would always be neoplasia.History :  The evaluation of any neck mass begins with a careful HISTORY . For example. whereas in older adults. one would tend to look for congenital lesions. . in younger patients. The history should be taken with because the differential diagnosis in mind directed questions can narrow down the diagnostic possibilities and focus subsequent investigations.

notice . How 6. 3. Other . 5.Approach of the neck mass * Personal data :1. Duration . 3. 2. Location . * HPI :1. masse . Age . Nationality . 4. Painfull / painless . 2. Size . Sex .

GI Symptoms . 3. wt loss . 7. 5. Symptoms of hypo. night sweat 6. Respiratory Symptoms . 4. . ( fever . Symptoms which indicate malignancy . OR hyper. Head & Neck Symptoms .Approach of the neck mass * Systemic Review :1. Symptoms which indicate infectious / inflammatory process . Compression Symptoms . 2. THYRODISM .

B. 4.Approach of the neck mass * The completion of History : 1. FH . contact with T. . Medication & radiation . Social History : smoking . 3. PMH . 6. alcohol . PSH . 5. Travel History . 2.

b. site . c. deglutition . shape . color . 2. d. relation to e. Inspection : a. Local Examination :1. relation to tongue protrusion . General appearance of the pateint .Approach of the neck mass * General Examinations :1. Vital Signs . .

f. consistence . g. temperature . e. . fluctuation . d. h. pulsatility . b.Approach of the neck mass 2. surface . tenderness . size . edge . Palpation : a. c.

Percussion : on the sternum for retrosternal extension of the thyroid . . Auscultation : for bruits .Approach of the neck mass 3. 4.

N. examine L.Approach of the neck mass * Complete Head & Neck Examination : 1. look to the head for any mass or ulcer . 2. .

examine thyroid .Approach of the neck mass 3. nose & throat examination . ear . 4. .

. .Approach of the neck mass 5. Mouth examination . laryngoscope . 6.

. Respiratory . GI .Approach of the neck mass * Systemic Examination : 1. 2.

. 3. ) . CBC :2. 4. PTH :. 5.Approach of the neck mass 1.( Thyroid ) .etc. ( Parathyroid ) . lymphoma ……. U/E :- ( infection . TFT :.( Parathyroid ) .TB 6-CXR .

FNAB is the STANDARD of diagnosis for neck masses .Approach of the neck mass Fine Needle Aspiration Biopsy (FNA # Currently. # Indication : Any neck mass .

either benign or 2. disease 3. Helps the clinician differentiate carcinoma from lymphoma. Also may allay patient fears for malignant malignant. FNAB separates inflammatory from neoplastic lesions. . # Contraindication : There are NO contraindications to FNAB.Approach of the neck mass # Benefits : 1.

and rapid technique that can be performed in the clinic . sensitive. a lateral neck mass is metastatic squamous cell carcinoma or lymphoma until proved otherwise inexpensive.Plz take this points to home :  Neck masses are very common  Approach with History and Physical exam will commonly lead to the correct diagnosis  75% of lateral neck masses in patients over 40 years are caused by malignant tumours  In the absence of overt signs of infection. .  Fine needle aspiration biopsy is an accurate.

org .cambridge.Refrences : www.ncbi.com/doc/2369226/Neck-Swelling www.scribd. journals.co.gov/pubmed/15944980 www.nlm.nih.ht www.nz/necklump/necklumpindex.neck.

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