NECK LUMPS

ANTERIOR TRIANGLE LUMPS

BRANCHIAL CYST:

• Located in anterior triangle.
• Contains cholesterol crystals.
• Usually before the age of 30 years.
• It emerges under the anterior border of the sternocleidomastoid muscle where the upper 1/3 meets the lower 2/3.
• Investigation: US and FNAC.
• Treatment: surgical removal.

CAROTID BODY TUMOUR

• Located in anterior triangle.
• It moves side to side but not up and down.
• It may be pulsatile.
• It usually does not cause bruit.
• It is located just anterior to the upper 1/3 of sternocleidomastoid muscle.
• Investigation: Doppler USS and arteriography.
• Treatment: Surgical extirpation.

PAROTID TUMOUR

• Located in the anterior triangle at the upper posterior region at the angle of the jaw.
• Usually patient age >40 years
• Investigation: USS, mump test will be negative.
• Treatment: Surgical

MID-LINE LUMPS

THYROGLOSSAL CYST

• Trans-illuminating mid-line lump which moves on tongue protrusion.
• Investigation: USS.
• Treatment: Surgical removal.

THYROID LUMP:

• Mid-line lump which moves on swallowing but not on tongue protrusion.
• Investigation:

1. All patients with thyroid nodules must have TSH measurement .
2. If low, then measure T4 & T3.
3. USS recommended in patients with atypical solitary nodules and multiple goiter:

– If it is a CYST then treatment is surgical removal

-If it’s solid then FNAC (It is recommended in all patients with solitary nodules)

THYROID CANCER:

Risk Factors:

• Pre- existing goiter
• Radiation of neck in childhood
• Types including Frequency and Clinical features:

1. Papillary (60%) : Solitary thyroid nodule
2. Follicular (25%) : Slow growing thyroid mass, symptoms are usually from distant metastases.
3. Anaplastic (10%) : Rapidly growing thyroid mass causing tracheal and oesophageal compression.
4. Medullary (5%) : Thyroid lump, may have MEN II A ( medullary carcinoma, pheochromocytoma, hyperparathyroidism) or MEN II B (medullary thyroid carcinoma, pheochromocytoma, multiple mucosal neuromas, Marfanoid habitus ) syndrome.

Management:

• Papillary:

-Surgery: total thyroidectomy & removal of involved lymphnodes

-Adjunctive treatment: L-thyroxine to suppress TSH (it stimulates papillary tumour growth)

-Prognosis: Excellent

• Follicular

-Surgery: Thyroid lobectomy or total thyroidectomy if metastases are present.

-Adjunctive treatment: Radioactive iodine for distant metastases and L-thyroxine for replacement therapy to suppress TSH.

• Anaplastic

-Surgery: only palliative to relieve pressure symptoms

-No radiotherapy chemotherapy

-Prognosis: Very poor

• Medullary

-Excluded phaeochromocytoma before treating

-Surgery: Total thyroidectomy & excision of regional lymphnodes

DERMOID CYST:

• Midline lump that does not move on swallowing or tongue protrusion.
• If patient is less than 20 years the dermoid cyst is likely.
• Investigation: USS
• Treatment: Surgical removal

POSTERIOR TRIANGLE LUMPS

CERVICAL RIB (THORACIC OUTLET SYNDROME)

• Located in the posterior triangle.
• It is an extension of C-7.
• It can cause compression of upper arm vein or nerves therefore it can cause tingling and numbness or swelling of the arm.
• Symptoms depend on the compressed structure.
• Investigation: Cervical spine X-ray
• Treatment: Surgical removal

CYSTIC HYGROMA

• Located in the posterior triangle.
• These are massive distended lymphatic vessels.
• These can cause compression of the airway.
• They present at birth and trans-illuminate brightly.
• Investigation: USS
• Management: Surgical removal

PHARYNGEAL POUCH:

• Located in the posterior triangle.
• It is a diverticulum of the esophagus which comes out between the inferior pharyngeal constrictor muscles.
• Symptoms: regurgitation of undigested food particles, halitosis, swelling in the neck, bulging in the neck after drinking, dysphagia.
• Investigation: If it present as mass in the neck then investigation is USS.

If it present as a mass in the neck then investigation is barium meal.

• Treatment : Surgical

SUBCLAVIAN ARTERY ANEURYSM:

• It is a pulsatile mass located in the posterior triangle at the base of sternocleidomastoid muscle.
• Investigation: Doppler USS
• Treatment: Surgical repair of the aneurysm.