![]() Working toward the diagnosis will involve clues from: Malignant tumours: sarcoma, chondrosarcoma, skin malignancy.Developmental abnormalities: branchial cyst, laryngocele, pharyngeal pouch, cervical rib.Congenital swellings: thyroglossal cyst, dermoid cyst, cystic hygroma, lymphangioma.Salivary gland problems: tumours, blocked ducts, infection and inflammation.Thyroid swellings: diffuse enlargement, nodules and cancers.Lipomas and other benign tumours: such as fibromas, chondromas, neuromas and vascular tumours.Infections of the skin: abscess, infected sebaceous cyst.Malignant lymph nodes: leukaemia, lymphoma, metastases.In children consider cat scratch disease, Kawasaki disease (more than one lymph node must be >1.5 cm and non-fluctuant - look for associated conjunctivitis, fever and desquamation).Non-infective causes, such as sarcoidosis and connective tissue disease.Parasitic causes, such as head lice, fungal infections, toxoplasmosis.Viral causes, such as common viruses causing upper respiratory tract infections, Epstein-Barr virus (EBV), cytomegalovirus, HIV, herpes simplex virus.Bacterial causes, such as beta-haemolytic streptococci, Staphylococcus aureus, tuberculosis and secondary syphilis.The most common cause is reactive lymph nodes: There are numerous possible causes of lumps in the neck. Taking note of general clues of systemic illness, such as jaundice, pallor, petechiae, bruising, excoriation.Checking for compression of the airway or vasculature.Examination for lymphadenopathy or organomegaly elsewhere.If parotid disease is suspected, identify the orifice of parotid duct and palpate with the patient's head tilted backwards. Examination of the mouth - for malignancy, dental issues. ![]() Examination of the ears, nose and throat.Examination of the skin of the head and neck for rashes, lesions or infection.Whether it moves when the person sticks out their tongue (thyroglossal cysts).įurther examination to help establish the cause may include:.Whether it moves on swallowing (thyroid gland, thyroglossal cysts).Whether it is a solitary lump or if there is more than one.How deep the lump is: whether it is intradermal (suggesting sebaceous cyst with a central punctum, or a lipoma), subcutaneous or within deeper tissue.Whether it is tender, hot, red, inflamed.Posterior triangle (bordered by the posterior border of sternocleidomastoid, the clavicle and the trapezius).Anterior triangle (bordered by the midline, the body of the mandible and the anterior border of sternocleidomastoid).
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