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How to Manage a SWELLING IN THE NECK

How to Manage a SWELLING IN THE NECK . Zaid Awad. History 1. General Age, Sex, Race Malaise, weight loss Fever, Rigors, Itching Loss of appetite Contact; TB, URTI Cough, SOB Smoking, Alcohol, Occupation, Travel. History 2. Swelling Duration Onset Progression Pain

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How to Manage a SWELLING IN THE NECK

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  1. How to Manage aSWELLING IN THE NECK Zaid Awad

  2. History 1 • General • Age, Sex, Race • Malaise, weight loss • Fever, Rigors, Itching • Loss of appetite • Contact; TB, URTI • Cough, SOB • Smoking, Alcohol, • Occupation, Travel

  3. History 2 • Swelling • Duration • Onset • Progression • Pain • Aggravating/Remitting factors • Overlying skin • Other swellings

  4. History 3 Head & Neck • Pain • Dysphagia /odynophagia • Voice change; • hoarseness/weakness • Discharge • Colour, Odour, Duration, Consistency • Bleeding • Epistaxis, Haemoptysis, Petechiae, Ecchymoses

  5. General Examination GENERAL • Skin Pallor/Cyanosis/Erythema /Jaundice • Dyspnoea • Nutritional Status BMI/muscle wasting • Distended Veins • Tremor • Pulse (rate, rhythm)

  6. Triangles of the Neck

  7. Examination INSPECT • Site • Size • Shape • Overlying Skin PALPATE • Consistency • Pulsation • Relation to muscle (contract/relax) • Other lumps

  8. Examination Movement • With swallowing • With protruding the tongue • By hand - two dimensions Auscultate • Bruit • Venous hum

  9. System Examination • Chest • Inspect Symmetry/Movement/respiratory muscle • Palpate Trachea/Chest Expansion/Apex beat • Auscultate Breath Sounds/Additional Sounds • Abdomen & Pelvis • Inspect Distension Veins Shape • Palpate Ascitis Masses Liver/Spleen/Kidney • Auscultate • Cardiovascular System • Pulse/Pressure

  10. Investigation • Blood Tests: • FBC, U&E, LFT, • If required: TFT, Calcium, Calcitonin • Microbiology & Immunology • Thyroid Antibodies, Swabs, Cultures • Radiology • CT/MR/US/Radio-isotope scan • Cytohisopathology • FNAC/Biopsy

  11. Radiology GENERAL • CXR • CT Chest, Abdomen & Pelvis • Liver USS Swelling • MRI • Ultrasound Scan +/- FNAC

  12. Cyto/Histopathology • FNAC • True Cut/Wide Bore • Tissue Biopsy • Incisional • Excisional

  13. Origin • Lymphadenopathy • Thyroid/Parathyroid gland • Salivary Gland (parotid, submandibular…) • Thyro-glossal Cyst • Branchial Cyst • Carotid Body Tumour • Cystic Hygromata • Pharyngeal Pouch • Sterno-mastoid Tumour • Cervical Rib

  14. Common Sites

  15. LYMPHADENOPATHY INFLAMMATORY NEOPLASTIC BENIGN ACUTE Viral, Bacterial, Fungal.. MALIGNANT CHRONIC PRIMARY (Lymphoma Sarcoma..) NON-INFECTIVE (Sarcoid/ Rheumatoid) SECONDARY H&N and visceral cancer INFECTIVE (TB/Syphilis)

  16. Thank You

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