Neck swelling - History taking, Causes, Classification
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Transcript of Neck swelling - History taking, Causes, Classification
NECK SWELLING
• History Taking• Causes & Classification
BY: IZATTY LIM (0308188) BATCH 4
BIODATA
HISTORY TAKING
Age
Gender
Occupation
HOPI NECK SWELLING
HISTORY TAKING
When do you first notice the lump? Rule of 7:
7 days = inflammatory/infection
7 weeks/months = tumour
7 years = congenital/development
What do you think is the cause? History of trauma Previous TB
How do you notice it? Noticed accidentally Told by others Painful
How does the lump disturbs you? Associated symptoms
pain, discharge, dysphagia, dyspnea, cosmetically disfiguring, fear of malignancy
Any changes to the lump since you first notice it? Size
Has the lump ever disappears before? Lying down supine Any activity
Do you ever had any other lumps before this? Multiplicity
Systemic Review
Head & Neck symptoms Pain in mouth / throat Mouth ulceration Nasal discharge Pain / blockage of airway Voice changes Difficulty breathing
Systemic illness Suggestive of malignancy
Anorexia, weight loss and symptoms from other systems Suggestive of infection
Malaise, fever, rigors, local symptoms
HISTORY TAKING
PAST MEDICAL HISTORY
DRUG & ALLERGY
FAMILY HISTORY
SOCIAL HISTORY
HISTORY TAKING
Thyroid cancer & radiation Previous skin cancer / lesion
Smoking Chewing tobacco Alcohol
Malignancy
Causes of Neck Swelling
CAUSES
Inflammatory / Infection Lymphadenopathy Bacterial / viral Granulomatous Tuberculous Cat-scratch Fungal Sarcoidosis Sialadenitis Parotid Submaxillary
Neoplasia Metastatic
• Unknown primary• Epidermoid carcinoma• Primary head & neck• Melanoma
Primary• Adenocarcinoma• Thyroid• Lymphoma• Salivary• Lipoma• Glomus vagale• Carotid body tumor• Rhabdomyosarcoma
Congenital / Developmental Sebaceous cysts Branchial cleft cysts Thyroglossal cysts Lymphangioma/hemangioma Dermoid cyst Ectopic thyroid tissue Layngocele Thymic cysts
SUPERFICIAL o Sebaceous cysto Lipomao Dermoid cysto Abscess
Lymph nodes
CAUSES & CLASSIFICATION
DEEP Anterior Triangle
o Move with swallowing Thyroid Thyroglossal cyst Lymph node
o Do not move with swallowing Salivary gland Brachial cyst Carotid body tumor Carotid aneurysm
Posterior Triangleo Cervical ribo Subclavian artery aneurysmo Pharyngeal pouch o Cystic hygroma
Miscellaneous cysts Dermoid cyst Thyroglossal duct cyst Brachial clelf cyst Cystic hygroma
CAUSES & CLASSIFICATION
Midline neck masses Thyroglossal duct remnants (cysts) Dephian lymph nodes Pryramidal lobe of thyroid gland
*Mass at sternal notch: tuberculous abscess, dermoid cyst, or a fatty tumor associated with Cushing's syndrome similar to the Dowager's hump. Fullness of the sternal notch can occur in leukemia (Jaccoud's sign)
Lateral neck masses Brachial cysts Carotid body tumors
Unilateral Neck swelling
Parotid & submandibular glands
Bilateral Neck Swelling Mikulicz’s disease Bilateral parotitis
Dehydration Drug effect (sulfonamides, iodides, propythiouracil) Infection (chriomeningitis or mumps) Malignancy (leukemia, lymphoma) Metabolic disease (alcoholism, malnutrition, vit A deficiency, DM) Autoimmune disease (SLE, sarcoidosis)
CAUSES & CLASSIFICATION
1) Jones N, Hibbert J, Luxon LM. Scott-Brown’s Otorhinolaryngology: Head
and Neck Surgery cd-rom (A Hodder Arnold Publication). 7th ed. Gleeson MJ, Clarke RC, Browning GG, editors. London: Oxford University Press, USA; 2008.
2) Schwetschenau E, Kelley DJ. The Adult Neck Mass [Internet]. 2002 [cited 2015 Sep 14]. Available from: http://www.aafp.org/afp/2002/0901/p831.html
3) Williams ME. Assessment of the Neck and Lymph Nodes in the Elderly Patient [Internet]. Medscape. 2009 [cited 2015 Sep 14]. Available from: http://www.medscape.com/viewarticle/712256_5
4) Neck Lump [Internet]. Fastbleep Biology Notes. [cited 2015 Sep 14]. Available from: http://www.fastbleep.com/biology-notes/9/11/356
REFERENCES
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