neck swelling , syed alam zeb
TRANSCRIPT
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NECK SWELLING
Dr.Syed Alam Zeb
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DIFFERENTIAL DIAGNOSIS
• ENLARGED LYMPH NODES: Due to, Bacterial, Viral infections. Tuberculosis. Leukemias, Lymphomas or mets. from tumours.
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• SWELLING IN THE ANGLE OF THE JAW: May be due to,
Enlarged jugalodiagastric lymph nodes.
Cystic Hygromas in children.
Enlarged submandibular or parotid gland.
Carotid body tumour.
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• MIDLINE SWELLINGS:
Ludwigs angina.
Enlarged submental lymph nodes.
Thyroglossal cysts.
Thyroid enlargement.
Thymic enlargement.
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• LATERAL SWELLINGS:
Lymph nodes.
Collar stud’s absceses.
Branchial Cysts.
Thyroid swelling.
Pharyngeal pouch.
Laryngocele.
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• Lipomas, Neurofibromas, Haemangiomas, Dermoid and Sebacious cysts can occur any where in the neck area.
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CYSTIC HYGROMA IN A CHILD
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COLLAR STUD’S ABSCESS
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PAROTID TUMOUR
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THYROGLOSSAL CYST
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THYROID ENLARGEMENT
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MANAGEMENT
• Take detail history.• Thorough examination of head and neck
area.• Determine the nature of swelling.• Investigate accordingly.• Consider biopsy, FNAC or excision.• Definite treatment depends on the nature of
swelling.
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THYROID ENLARGEMENT
CAUSES OF THYROID ENLARGEMENT: 1 .Multinodular goiter due to iodine deficiency. 2.Single nodule which may be a dominant nodule in
MNG.,tumor, or cyst. 3.Generalized enlargement like toxic goiter in grave’s disease,
nontoxic goiter of puberty.
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• 4. Thyroid tumors: Papillary ca, Follicular ca, Ana plastic ca, Medullary ca, Lymphomas or secondary tumors.
• 5.Thyroiditis like Hashimoto’s disease and Riedels thyroiditis.
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MANAGEMENT OF THYROID NODULE
• History.• Examination.• Ultrasound neck.• FNAC.• TFTs, T3,T4 and TSH.• Thyroid scan.• Bone scan, chest x-ray and liver us in tumors.
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TOXIC GOITER
• Caused either by graves’ disease or toxic adenoma.
• Clinical features include palpitations, sweating, loss of weight and increased appetite. Patient looks nervous, has tremors, palm sweating, increased pulse rate and protruding eyes..exophthalmoses.
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Toxic goiter cont:
• Investigations show a rise in T3 ,T4 and fall in TSH.
• Thyroid scan will show either a hot nodule or generalized enlargement with increased uptake.
• Initially patient is treated with beta blockers and antithyroid drugs.
• Surgery considered when patient is euthyroid
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SURGERY FOR GOITER
• MNG and Graves disease: Subtotal thyroidectomy.
• Toxic nodule/ malignant nodule: Thyroid lobectomy ..
• In malignant cases total thyroidectomy is sometimes performed .
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POST-OPERATIVE COMPLICATIONS
• Hemorrhage.
• Haematoma formation.
• Recurrent laryngeal nerve damage.
• Hypothyroidism.
• Hypocalcaemia.
• Keloid scar formation.
• Tracheomalacia.
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HYPERPARATHRODISM
CAUSES:
Hyper secretion of parathyroid hormone either due to Adenoma of one of the four parathyroid glands or due to hyperplasia of all the four glands.
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• PRIMARY HYPERPARATHYRODISM: When the glands are producing increased amounts of PTH.
• SECONDARY HYPERTHYRODISM: When there is demand for increased amounts of PTH.as in chronic renal failure.
• TERTIARY HYPERTHYRODISM: Initially there is demand for increased amounts, but later on the glands become autonomous without demand.
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• PTH regulates the serum Calcium levels.
• In hyperparathyroidism the serum calcium levels are high.
• PTH acts on the bones and mobilizes the calcium from there.
• Bones become very weak, prone to fractures.
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CLINICAL FEATURES
• 50% patients are asymptomatic.
• Majority present with dyspeptic symptoms.
• Some present with bone pains and spontaneous fractures.
• Kidney stone formation very common in these patients.
• Few patients have psychiatric problems.
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INVESTIGATIONS
• Tests for the confirmation/ diagnosis of the disease.
• Tests for the localization of hyper functioning parathyroid gland.
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TESTS FOR THE DIAGNOSIS
• Serum calcium, usually elevated.
• 24 hrs urinary calcium is raised.
• Serum phosphate is low.
• Serum alkaline phosphatse is raised.
• Serum PTH levels are elevated.
• Skeletal survey for bone changes.
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TESTS FOR LOCALIZATION
• Ultrasound neck.
• MRI.
• Isotope scans.
• Selective venous sampling.
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X-ray in hyperparathyroidism
• Resorption of the terminal phalyngeal bones is typical.
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• Osteitis fibrosa cystica. Multiple cysts are formed in the bones.
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ISOTOPE SCANS
• CYSTA-MIBI scan showing a parathyroid adenoma.
• Thallium-technetium subtraction scan is also useful.
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TREATMENT
• If there is adenoma of the gland, excise that particular gland.
• If there is hyperplasia of all the four glands, excise all the four, but reimplant some parathyroid tissue in to the sternomastoid muscle.