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Neck Masses
Further links |
Etiology |
I. Congenital and developmental:
- Thyroglossal cyst.
- Branchial cyst.
- Dermoid cyst.
- Cystic hygroma.
- Sebaceous cyst.
II. Inflammatory:
1. Of Lymph Nodes
Acute:
Reactive nodes (Viral and bacterial).
Chronic:
Tuberculosis.
Sarcoidosis.
AIDS.
Non-specific inflammatory nodes.
Toxoplasmosis.
Brucellosis.
Malaria.
Fungal.
2. Of Salivary Glands
Sialadenitis, sialolithiasis, Sjogrens syndrome, Heerford
syndrome, diabetes, Cushing,s disease, myxoedema, etc.
3. Of Thyroid gland
Thyroiditis (Hashimotos, Dequevains, Riedels).
4. Of Parapharyngeal space
Cellulitis, and abscess.
III. Neoplastic:
Lymph nodes:
Primary
Secondaries.
Of Other organs:
Salivary glands,
thyroid,
blood vessels,
nerves,
muscles,
paraganglionic tissue, etc.
IV. Miscellaneous:
- Laryngocoeles.
- Pharyngeal and hypopharyngeal diverticula.
- Drug induced; penicillin, streptomycin, INH,
thiouracil, phenacetin, and heparin.
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General Considerations: |
When examining a patient with a neck mass, the physicians first
consideration should be the patients age group: paediatric (up to 15 years), young
adult (16 to 40 years), or late adult (over 40).
The incidence of different types of swellings
vary in each group:
Inflammatory, congenital / developmental,
Neoplasia, malignant, benign.
Inflammatory, congenital / developmental,
neoplasia, benign, malignant.
Neoplasia (Malignant > benign), inflammatory,
congenital / developmental.
- The next consideration should be the location of the neck mass.
Developmental and congenital masses appear in consistent locations. The location of
neoplasms are both diagnostically and prognostically significant.
- Neck masses and their locations
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Midline and Anterior Neck |
Anterior Triangle |
Posterior Triangle |
Congenital
/ Developmental
- Thyroglossal cyst
- Laryngocele
- Dermoid
Inflammatory
Neoplasms
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Congenital
/ Developmental
- Branchial cyst
- Thymic cyst
Inflammatory
- Lymphadenitis
- Sialadenitis
Neoplasms
- Metastatic lymph node from:
- Oropharynx
- Oral cavity
- Hypopharynx
- Larynx
- Lymphoma
- Carotid Body tumor
- Glomus
- Hemangioma
- Neurilemmoma
- Salivary gland tumors
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Congenital
/ Developmental
Inflammatory
Neoplasms
- Metastatic lymph node from:
- Nasopharynx
- Scalp
- Breast
- Stomach
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Diagnosis: |
- Specific historic and physical findings that can reduce the
possible causes should be sought so that only a limited number of tests are needed for
differential diagnosis.
- An exhaustive examination of the head and neck is essential. The
physician must not be distracted by the mass. All areas must be visualized and palpated
even when no lesion is seen.
The location of the mass , size of
the lesion , fixation to the surrounding structures, consistency, and the presence of any
pulsations and thrills. Detecting the distinct odour of wet keratin and necrotic tumor on
the breath is also important
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Investigations: |
- For a pulsatile, compressible, or a mass with a thrill or bruit,
angiographic and ultrasonographic studies may be ordered to differentiate vascular
problems from neoplasms such as carotid body tumor and glomus.
- Ultrasound may also distinguish between solid and cystic lesions,
or a congenital cyst from a lymph node, neurogenic tumor or thyroid tissue.
- For lesions in the areas of the salivary glands radionuclide
scanning, ultrasound and sialography are all useful in localizing the mass within or
outside the salivary gland..
- CT is most helpful.
- FNA
- Serologic or skin tests for fungal disease are not very helpful.
- Excision biopsy with pathologic examination and culture often is
the final diagnostic test.
- If biopsy reveals granulomas, consider;
tuberculosis, sarcoidosis, toxoplasmosis, catscratch disease, syphilis, tularemia,
leishmaniasis, and actinomycosis.
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