Neck Mass

Is any abnormal enlargement, swelling, or growth from the level of the base of skull to the clavicles

Anatomical Considerations

Prominent landmarks Hyoid bone Thyroid cartilage (men) Cricoid cartilage (women) Trachea Sternocleidomastoid muscle

Triangles of the neck

Anterior Anterior border of the SCM, midline, lower border of the mandible Subdivisions: inferior carotid, superior carotid, submandibular, submental Posterior Posterior border of SCM, clavicle, anterior border of trapezius Subdivisions: subclavian, occipital

Differential diagnosis

A. Middle neck mass 1- congenital - thyroglossal cyst - dermoid cyst - thymic tumor 2- cx. Lymph adenopathy: - inflammatory - neoplastic( metastasis) 3- neoplasm: -Benign: - lipoma ,chondroma ,isthmus swelling - malignant: - thyroid ca. 4- inflammations: - thyroiditis, - infected thyroglossal cyst

B.Lateral neck mass

1- cong. : lymphangioma lat. Thyroglossal cyst 2- developmental: - branchial cyst - laryngocoele -pharyngeal pouch cyst 3- swelling related to the gland : -submandibular = sialadenitis = stone = tumor - thyroid gland - goiter , tumor.

4- parapharyngeal tumors parotid tail, carotid body tumor

5- soft tissue swelling (ludwig`s angina) 6- cx. Lymphadinitis -acute( URTI) -chronic( tb, syph. AIDS) 7- cx. Ln . Tumor 1-lymphoma 2-metastatic 8- sternoclidomastoid muscle tumor 9 - cx. rib


Clinical evalutions
HISTORY: age chronicity associated symptoms/ dysphagia, otalgia, hoarsness… concurrent illnesses & past h. med / surg / drugs/ dxt exposure to infections smoking

Examinations

GENERAL CHARECTERS of the mass ; site,size,shape,surface,consistency,mobiliy &relation ASSOCIATED SIGNS; wt.loss,fever,pallor

INVESTIGATIONS

LAB. : - CBP, ESR ,B.FILM -throat swab for c/s -tub.t -serologic tests for HIV,CMV, EBV. RAD: - CXR u/ss ,MRI, Ct scan ,isotop Thyroid function tests F.N.A C, AFB, culture aerobic &anaerobic) EXCISIONAL BIOPSY

Fine Needle Aspiration Biopsy

Standard of diagnosis Indications Any neck mass that is not an obvious abscess Persistence after a 2 week course of antibiotics

EXCISIONAL BIOPSY

Present of signs& symptoms of malignancy Persist lymphadenopathy DX. Remain in doubt.

Thyroglossal Duct Cyst

Most common congenital neck mass (70%) 50% present before age 20 Midline (90%). Usually just inferior to hyoid bone (65%) Painless unless infected. Elevates on swallowing/protrusion of tongue Treatment is surgical removal (Sis trunk) after resolution of any infection


Thyroglossal Duct Cyst

Branchial Cleft Cysts

Branchial cleft anomalies 2nd cleft most common (95%) tracts between internal and external carotids Most common as smooth, fluctuant mass underlying the SCM Skin erythema and tenderness if infected Treatment Initial control of infection Surgical excision, including tract

Branchial Cleft Cysts

Lymphoma
More common in children and young adultsUp to 80% of children with Hodgkin’s have a neck massSigns and symptomsLateral neck mass only (discrete, rubbery, non tender)HepatosplenomegalyDiffuse lymphadenopathyFNAB – first line diagnostic testIf suggestive of lymphoma – open biopsyFull workup – CT scans of chest, abdomen, head and neck; bone marrow biopsy & full blood count.

Lymphoma

Vascular Tumors
Lymphangiomas and hemangiomas Hemangiomas often resolve spontaneously, while lymphangiomas remain unchanged CT/MRI may help define extent of disease

Vascular Tumors

Treatment Lymphangioma – surgical excision for;easily accessible lesions affecting vital functionsHemangiomas – surgical excision for rapid growth involving vital structures associated thrombocytopenia that fails medical therapy (steroids, interferon)


Vascular Tumors
(hemangioma
Cystic hygroma

Carotid Body Tumor

Rare in children Pulsatile, compressible mass Mobile medial/lateral not superior/inferior Clinical diagnosis, confirmed by angiogram or CT Treatment Irradiation or close observation in the elderly Surgical resection for small tumors in young patients

Carotid Body Tumor