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Neck History & Examination

Sep 19, 20244 min read

CM

History & Clinical Examination

Neck Examination

  1. Introduce, explain procedure, ideal exposure

Neck Inspection

When assessing lymph nodes of either sides, ask patient to expose them - palpate and discern any palpable mass - if none note to examiner that there is no palpable mass.

Surgery

History and physical examination of Neck & Thyroid gland

Dr. Ahmed Alghamdi

Causes of swelling

Congenital 1-3 causesCC

  1. Thyroglossal duct-cyst (Midline - connected to foramen caecum - goes up with protrusion)

    • can present with abcess - rupture // sepsis - treat with drainage - remove cyst and whole tract as prophylaxis - removing central portion of hyoid bone

  2. Cystic hygroma (benign neoplasm of lymphatic chains?) - can be diagnosed prenatally may complicate labor indication for cessearian section - typically found in posterior trunk at base of the neck - characteristically transilluminate

  3. Branchial Cyst - most commend second pharyngeal pouch - followed by third - can turn into abscess / fistula - can be bilateral

second pharyngeal pouch - junction between … derivative of pharyngeal pouch??CC

  1. Goiter - swallow indicative of goiter specific exam (exception thyroglossal cyst with tongue protrusion )

  2. LAP ⇒ M (P & S) / I (P & S) - MULTIPLE swelling of neck

    • Hard - carcinoma
    • Tender - infection tender
    • Rubbery - lymphoma

  3. Lipoma

  4. Epidermoid / Dermoid cyst

  5. Torticollis / sternocleidomastoid “tumor” - squint refractive when position is corrected, compensated neck

  6. Esophagus - crico area - anatomical weakness keyen dihesens adhencses?CC - kelien adhesens?? - zenker’s diverticulum or pharyngeal pouch or pharyngocele presents as lateral neck mass - halitosis bad breath due food found at diverticulum due regurgitation

pseudo false diverticulum - true when all layers are involved in contrary to submucosa only - only true example is mickel’s diverticulum

  1. Laryngocele?? - vocal cord presentation with neck mass

blow against nose maneuver - ? valsalva maneouver??

  1. Carotid Body Tumour or Chemodactoma or glomus tumor or potato tumor mass moves side to side, not up to down

  2. Salivary Gland Tumour submental malignancy???, rest are benign commonly

common benign Parotid tumor most common is pleomorphic adenoma followed by worthin tumor?? -

common malignancy mucloplemoid carcinoma, adenoin cystic

  1. Subclavian Artery Aneurysm commonly after RTA

  2. Rannula - retension cyst on mouth

  3. Neuroma & Neurofibroma & Neurofibromatosis

Plan for the examination of a patient with a goitre

  • Look at the whole patient for agitation, nervousness or lethargy.
  • Examine the hands for sweating, tremor, tachycardia.
  • Examine the eyes for exophthalmos, lid lag, ophthalmoplegia, chemosis.
  • Examine the neck. Always check that the lump moves with swallowing.
  • Palpate the cervical lymph nodes.

The eye signs of thyrotoxicosis

  • Lid retraction and lid lag

  • Exophthalmos, which also causes difficulty with convergence and absent forehead wrinkling when looking upwards

  • Ophthalmoplegia, particularly of the superior rectus and inferior oblique muscles (cannot look ‘up and out’)

  • Chemosis

Indication of thyroidectomy

A scheme for the diagnosis of swellings in the neck

(Deep to the deep fascia)

After your examination you should be able to answer four critical questions: Is there one or more than one lump? Site? Solid or cystic? Does it move with swallowing?

Multiple lumps are invariably lymph nodes A single lump: In the anterior triangle that does not move with swallowing

Solid:

  • A lymph node
  • Carotid body tumour

Cystic:

  • Cold abscess
  • Branchial cyst

In the posterior triangle that does not move with swallowing Solid:

  • A lymph node

Cystic:

  • Cystic hygroma
  • Pharyngeal pouch

Pulsatile:

  • Subclavian aneurysm

In the anterior triangle that moves with swallowing Solid:

  • Thyroid gland
  • Thyroid isthmus lymph node

Cystic:

  • Thyroglossal cyst

Surgery Neck

References

  • Harrison’s Principles of Internal Medicine, 20th Edition*
  • Cecil Textbook of Medicine, 25th Edition*
  • The American Thyroid Association Guidelines for the Management of Thyroid Nodules and Differentiated Thyroid Cancer*

TB - couch / blood / endemic TB - presented with LN collapse - with white exudate cessation

Pleomorphic adenoma & fibroadenomaRR

Graph View

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