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 nb.gif (14684 bytes)   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, Sjogren’s syndrome, Heerford syndrome, diabetes, Cushing,s disease, myxoedema, etc.

3. Of Thyroid gland

    • Thyroiditis (Hashimoto’s, Dequevain’s, Riedel’s).

4. Of Parapharyngeal space

    • Cellulitis, and abscess.

III. Neoplastic:

    1. Lymph nodes:
    • Primary
    • Secondaries.
    1. 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.
General Considerations:
    • When examining a patient with a neck mass, the physicians first consideration should be the patient’s 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:

    • Paediatric (0 - 15):

Inflammatory, congenital / developmental, Neoplasia, malignant, benign.

    • Young adult (16 - 40):

Inflammatory, congenital / developmental, neoplasia, benign, malignant.

    • Late adults (over 40):

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

Midline and Anterior Neck

Anterior Triangle

Posterior Triangle

Congenital / Developmental
  • Thyroglossal cyst
  • Laryngocele
  • Dermoid

Inflammatory

  • Lymphadenitis

Neoplasms

  • Thyroid
  • Lymphoma
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
Congenital / Developmental
  • Cystic hygroma

Inflammatory

  • Lymphadenitis

Neoplasms

  • Metastatic lymph node from:
  • Nasopharynx
  • Scalp
  • Breast
  • Stomach
  • Lymphomas
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
    •  

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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