Question #624
Your auntie is concerned that she has a lump in her neck, in an attempt to reassure her you correctly remember
There are a large number of different causes of lumps in the neck and it is important to be able to distinguish them clinically. Important things to consider are the location of the lump, the age of the patient, is the lump soft, hard, single of multiple and any associated symptoms.
- Thyroid lumps are midline and move on swallowing. A goitre is a diffuse swelling of the thyroid not associated with malignancy or inflammation.
- A thyroglossal cyst forms in the residual thyroglossal tract down which they thyroid gland descended during development. It will be located in the midline, move on swallowing, and ascend on protrusion of the tongue.
- A branchial cyst is a congenital abnormality due to failure of the 2nd pharyngeal arch to cover the pharyngeal clefts. It is most commonly located on the anterior border of sternocleidomastoid and may become infected.
- Cystic hygromas are a congenital abnormality of development of the lymph system. They present as a large lymph filled swelling in the posterior triangle.
- A sternocleidomastoid tumour is not a tumour but rather a fibrosis mass within the muscle usually occur following trauma of childbirth. It is often associated with torticollis.
- A tender lump is more likely to be an inflamed or infected lymph node, similarly multiple lumps are likely to be lymph nodes.
- A carotid body tumour usually presents as a slow growing painless lump in the anterior triangle.
- A pharyngeal pouch is a diverticulum that forms between the two components of the inferior constrictor muscle of the pharynx. It is only rarely palpable.
- Subclavian aneurysms are very rare but may present as a pulsatile mass in the posterior triangle.