Neck mass differential diagnosis

Neck mass differential diagnosis

1. Differential diagnosis of neck swellings Dr sumer yadav Mch – plastic and reconstructive surgeon [email protected]

2. Tutorial outcomes Understand the differential diagnosis ( DDx ) Know the aetiology of head and neck swellings Know the investigation used in the management process [email protected]

3. 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 [email protected]

4. What Is DDx ? the distinguishing of a disease or condition from others presenting with similar signs and symptoms Emil Kraepelin father of DDx [email protected]

5. 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 . [email protected]

6. 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 [email protected]

7. DDx of neck swellings [email protected]

8. Approach of the neck mass [email protected]

9. DDx of neck swellings based on the anatomical site: [email protected]

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13. 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 [email protected]

14. Management process [email protected]

15. Approach of the neck mass 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. Hints on surface Anatomy [email protected]

16. Approach of the neck mass 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. Hints on surface Anatomy [email protected]

17. Approach of the neck mass 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. Hints on surface Anatomy [email protected]

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19. Approach of the neck mass 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 . Hints on surface Anatomy [email protected]

20. Approach of the neck mass Hints on surface Anatomy The prominent landmarks of the neck are : 1. hyoid bone, 2. Thyroid cartilage, 3. Cricoid cartilage, 4. Trachea, 5. Sternocleidomastoid muscles. [email protected]

21. Approach of the neck mass * 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 . History [email protected]

22. Approach of the neck mass * 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 . History [email protected]

23. Approach of the neck mass * 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 . Physical Examination [email protected]

24. Approach of the neck mass 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 . Physical Examination [email protected]

25. Approach of the neck mass 3. Percussion : on the sternum for retrosternal extension of the thyroid . 4. Auscultation : for bruits . Physical Examination [email protected]

26. Approach of the neck mass * Complete Head & Neck Examination : 1. look to the head for any mass or ulcer . Physical Examination Don't Forget 2. examine L.N. [email protected]

27. Approach of the neck mass 3. examine thyroid . Physical Examination Don't Forget 4. ear , nose & throat examination . [email protected]

28. Approach of the neck mass 6. laryngoscope . 5. Mouth examination . Physical Examination Don't Forget 7. esophagi scope . Modality Basic Indications Ultrasound Good for pediatric neck masses, thyroid masses. Differentiates cystic versus solid. Computed tomography Workhorse 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 scanning Useful for midline lesions in children—differentiates functioning from nonfunctioning tissue. Positron emission tomography Useful 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 . [email protected]

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32. 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. [email protected]

33. 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). [email protected]

34. Radiographic Investigation of the Head 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. [email protected]

35. Radiographic Investigation of the Head 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. [email protected]

36. Modality Basic Indications Ultrasound Good for pediatric neck masses, thyroid masses. Differentiates cystic versus solid. Computed tomography Workhorse 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 scanning Useful for midline lesions in children—differentiates functioning from nonfunctioning tissue. Positron emission tomography Useful 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 . [email protected]

37. Biopsy F.N.A.C – Fine Needle Aspiration Biopsy is Safe Rapid Inexpensive Presurgical planning Avoids open biopsy [email protected]

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39. Treatment modalities Medical Surgical Radiotherapy [email protected]

40. Thanks [email protected]