Neck Lumps: Differential Diagnosis Quiz

Neck Lumps: Differential Diagnosis

• Initial Assessment: Evaluating a neck lump requires a comprehensive approach:
  • Detailed patient history
  • Physical examination of neck (including triangles, lymph node palpation)
  • Anatomical knowledge of neck triangles aids differential diagnosis.

Potential Causes of Neck Lumps

• Malignancy:
  • Metastatic cancer is a significant possibility, often originating from breast (draining to supraclavicular area) or upper gastrointestinal tract (Virchow's node). Lung cancer can also present in the supraclavicular region.
  • Important to consider malignancy in the differential diagnosis regarding the patient's life expectancy.
• Infection:
  • Lymph node enlargement (lymphadenopathy) can be caused by infections, often affecting jugulodigastric (tonsil-related) nodes.

History Taking: Crucial Considerations

• Likelihood of malignancy: Patient history directs evaluation.
• Multiple lumps? A patient with multiple lumps is more likely to have a systemic issue.
• Age-specific considerations:
  • Children: Infections are frequent; tonsillitis often presents with cervical lymphadenopathy. Active immune systems can cause lymph node enlargement. Ask about preceding infections. Lymphoma, though rare, can occur in children; note persistent, enlarging nodes. Thyroid lesions, also rare, warrant concern if growing.
  • Adolescents: Benign lesions are more common, but infections (URTs, mononucleosis - characterized by painful swallowing, exudate on tonsils, systemic symptoms) can cause lymphadenopathy. Contact sports avoidance is advised post-infection due to possible hepato-splenomegaly and liver function changes. Lymphoma is possible, requiring a history of persistent node enlargement and evaluation of weight loss, night sweats, and fever. Nasopharyngeal carcinoma, rare but present, can cause unilateral conductive hearing loss. Melanoma, though less common in the neck, should be considered.
  • Adults: Malignancy is relatively more common. Key questions include duration of the lump, change in size (rate), presence of additional lumps, and concerning symptoms. Weight loss, night sweats, fever, progressive dysphagia (solid, minced, liquid), and odynophagia are red flags. Hyperthyroidism and TB can present with weight loss

Specific Lesions in the Neck

• Thyroglossal cysts: Midline neck swelling that moves with protrusion of the tongue, due to remnant tissue connection (foramen caecum).
• Branchial cysts: Should be considered alongside thyroglossal cysts.
• Apical Lung Tumors: Can present as a neck lump.

Airway Compression

• Laryngeal/Tracheal Tumors: Large thyroid nodules, especially in the supine position, can compress the trachea. Stridor (noisy breathing) and hoarseness are significant symptoms of upper airway obstruction, especially a supraglottic mass. The vocal cords are a critical point; hoarseness might indicate recurrent laryngeal nerve paralysis. Tracheostomy might be necessary.