neck mass differential diagnosis

Differential diagnosis of

neck swellings

DR SUMER YADAV

MCH – PLASTIC AND RECONSTRUCTIVE SURGEON

Tutorial outcomes

Understand the differential diagnosis

(DDx)

Know the aetiology of head and neck

swellings

Know the investigation used in the

management process

Approach of the neck mass

The general definition of a neck mass is

any abnormal enlargement, swelling, or

growth from the level of the base of skull to

the clavicles .

Definition

What Is DDx ?

the distinguishing of a disease or

condition from others presenting with

similar signs and symptoms

Emil Kraepelin father of DDx

Head and neck swellings

Numerous masses may develop in the head and

neck, and these may also be termed swellings,

growths, tumors, lumps, and bumps.

Although some swellings are cancerous , many are

not.

However, it is important to investigate if any

abnormal bump or swelling persists for more than

two weeks.

what type of structures found in the

head and neck region

Lymph nodes

Salivary glands

Thyroid and parathyroid glands

Thymus

Potential spaces (fascia spaces)

Skin ,fat , fascia, muscles, nerves, vessels,

bones

DDx of neck swellings

DDx of neck swellings based on the

anatomical site:

Symptoms Associated with Head &

Neck Lumps

Change in the voice including hoarseness that

persists for more than two weeks

Growth in the mouth

Swollen tongue

Blood in the saliva or phlegm

Swallowing problems

Management process

History Clinical

examination Radiographic investigations

Biopsy


The anterior triangle is

delineated by :

1. The anterior border of the SCM laterally,

2. The midline medially,

3. The lower border of the mandible

superiorly.

The SCM divides each side of the

neck into two major triangles,

anterior and posterior.


The borders of the posterior

triangles are :1. The posterior border of the SCM

anteriorly,

2. The clavicle inferiorly,

3. The anterior border of the trapezius

muscle posteriorly.


The thyroid gland : is usually

palpable in the midline below the

thyroid cartilage.

The parotid glands : are located

in the preauricular area on each side in

the lateral neck. The tail of each parotid

gland extends below the angle of the

mandible, inferior to the earlobe.


Submandibular glands : are

located within a triangle bounded by ….

the sternocleidomastoid muscle, the

posterior belly of the digastric muscle,

and the body of the mandible.

Lymph nodes : are

located throughout the head

and neck region .


The prominent landmarks of the

neck are :

1. hyoid bone,

2. Thyroid cartilage,

3. Cricoid cartilage,

4. Trachea,

5. Sternocleidomastoid muscles.


* Personal data :-

1. Age .

2. Sex .

3. Nationality .

* HPI :-

1. Duration . 2. Location .

3. Size . 4. How notice .

5. Painfull / painless . 6. Other masse .

7. Progression . 8. Trauma .


* Systemic Review :-

1. Symptoms of hypo. OR hyper. THYRODISM .

2. Symptoms which indicate malignancy .

3. Respiratory Symptoms .

4. GI Symptoms .

5. Symptoms which indicate infectious / inflammatory process . ( fever , wt loss , night sweat

6. Head & Neck Symptoms .

7. Compression Symptoms .


* General Examinations :-

1. Vital Signs .

2. General appearance of the pateint .

* Local Examination :-

1. Inspection :

a. site . b. shape .

c. color . d. relation to deglutition .

e. relation to tongue protrusion .


2. Palpation :

a. temperature . b. tenderness .

c. size . d. surface .

e. edge . f. consistence .

g. fluctuation . h. pulsatility .

i. relation to skin . j. mobility .

k. relation to underlying structures .


3. Percussion :on the sternum for retrosternal extension of the thyroid .

4. Auscultation :for bruits .


* Complete Head & Neck Examination :

1. look to the head for any mass or ulcer .

2. examine L.N.


3. examine thyroid .

4. ear , nose & throat examination .


6. laryngoscope .

5. Mouth examination .

7. esophagi scope .

Summary of examination Examination of some masses / swelling may allow a physician to determine their

cause based on location, size, and consistency.

In other cases, however, additional tests may be required.

Changes in the skin – It is important to examine changes in the skin that could

indicate basal cell carcinoma, squamous cell cancer, and malignant melanoma.

Persistent Ear Pain or ear pain while swallowing may be a symptom of infection

or a growth in the throat.

Radiographic Investigation of the Head

and Neck Masses

MRI – Magnetic Resonance Imaging can clearly

highlight soft tissue pathologies better than the C.T. Scan.

It uses a magnetic field rather than x-rays (radiation).


and Neck Masses CT SCAN – Computed tomography is

less accurate than M.R.I for the soft

tissue examination

very useful to locate bony tumors and

their dimensions and extensions.

C.T with contrast is used to enhance

the visibility of abnormal tissue during

examination.


and Neck Masses PET (Positron Emission Tomography)

and SPECT (Single Photon Emission

Tomography) are useful after diagnosis

to help determine the grade of a tumor or

to distinguish between cancerous and

dead or scar tissue.

They involve injection with a

radioactive tracer.

Modality Basic Indications

Ultrasound Good for pediatric neck masses, thyroid masses. Differentiates cystic versus solid.

Computed tomographyWorkhorse imaging modality for adult neck masses. Provides three-dimensional

relationships, excellent detail of mucosal disease and involvement of adjacent bone.

Magnetic resonance imaging

Superior soft tissue delineation. Good for lesions of the salivary glands and tongue

(where dental amalgam may obscure the view on a CT). Modality of choice for

determining nerve enhancement. Consider for thyroid imaging in cases necessitating

radioiodine.

Radionuclide scanningUseful for midline lesions in children—differentiates functioning from nonfunctioning

tissue.

Positron emission tomographyUseful for staging of head and neck malignancies. Can be used in cases of unknown

primary malignant neck masses or treated neck disease.

Angiography/magnetic resonance

angiography/computed tomography angiography

Useful for lesions encasing the carotid and vascular lesions. Conventional angiography

should be considered for preoperative assessment in cases of potential carotid artery

sacrifice or where embolization is required.

Plain radiograph Generally should not be considered in the workup of a neck mass.

Biopsy

F.N.A.C – Fine Needle Aspiration Biopsy is

Safe

Rapid

Inexpensive

Presurgical planning

Avoids open biopsy

Treatment modalities

Medical

Surgical

Radiotherapy

Thank

s

neck mass differential diagnosis

Health & Medicine