Core Presentations

Question 1

Neck Lumps - Triangles

Answer 1

• *Level 1** - submental/mandibular level
• normal structures: salivary glands, lymph nodes, myohyoid, digastric, vessels, nerves
• *Levels 2/3/4** - under sternocleidomastoid
• normal structures 2: vessels, nerves (X), lymph nodes, carotid bodies), parotid tail can extend into level 2
• normal structures 3: as above
• normal structures 4: as above + thoracic duct
• *Level 5** - posterior neck triangle
• normal structures: CNXI, lymph nodes, brachial plexus,
• *Level 6** - central
• normal structures: thyroid, trachea, oesophagus, larynx, lymph nodes, vessels (anterior jugular), nerves

Question 2

Neck Lumps - DDx

Answer 2

**Inflammatory/Infectious: **

Acute: bacterial lymphadenitis, glandular fever, reactive lymphadenopathy due to URTI.

Subacute/chronic lymphadenitis: TB/atypical mycobacterium, cat scratch disease

Neck abscesses: traumatic, foreign body, dental abscesses

Salivary: sialodenosis/itis/lithiasis, Sjogren‟s syndrome

Granulomatous disease:

Sarcoidosis, Kimura‟s Disease etc

Neoplasms:

Lymph nodes: primary (lymphoma/leukaemia) vs. metastatic (SCC, melanoma, Merkel Cell carcinoma, salivary gland, thyroid, intra-abdominal or thoracic malignancy)

Salivary Gland

Sarcoma

Thyroid: adenoma vs. carcinoma

Nerve derived: neuroma, neurofibroma, schwannoma, sarcomas

Paraglanglioma (benign vs. malignant)

Lymphovascular malformations:

Haemangioma

Lymphagioma

Cystic hygroma

AVMs

Congenital abnormalities:

Ectopic thyroid gland

Branchial cleft cyst

Dermoid

Thyroglossal duct cyst

Thyroid

Multinodular or diffuse enlargement

Other:

Mediastinal masses with neck extension

Histiocytosis

Castleman‟s disease

Gout/psuedogout