Neck examination

 

Neck examination

Lymph nodes examination (up-and-down technique)
  1. Palpate from the chin backwards to below the ears (submental – submandibular – parotid glands – pre-auricular)
  2. Move your hand behind the ears (post-auricular) and palpate DOWN the anterior border of sternomastoid to the clavicle (anterior triangle including jugulodigastric)
  3. Move laterally along the clavicle (supraclavicular – infraclavicular) then UP the posterior border of sternomastoid (posterior triangle)
  4. Finish by palpating back of the scalp (occipital nodes)
+ Face and scalp examination (thyroid examination if the swelling in front of the neck)

+ Area above the umbilicus (breast examination in females)

+ ENT examination searching for primary site of infection or neoplasia

+ Abdominal examination (hapatomegaly and splenomegaly) and the rest of lymphoreticular system (other groups of lymph nodes)

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image source: http://pedsinreview.aappublications.org/content/34/5/216

TAKING HISTORY FROM A PATIENT WITH A neck swelling

Follow the general scheme (on this page)  and use the following set of symptoms in the part of “Other symptoms in Relation to the main complaint

  • Lump
  • Ulcer
  • Pain
    • In mouth
    • In throat
  • Nasal discharge
  • Change of voice
  • Dysphagia
  • History of its possible cause
    • Constitutional manifestations (suggesting inflammatory disorder)
    • Toxic manifestations (suggesting TB)
    • Symptoms of malignancy

Differential diagnosis of Neck swellings

Anatomy is the clue

  • Skin and subcutaneous tissue
  • Artery
  • Vein
  • Nerve
  • Lymphatics
  • Lymph nodes
  • Bones
  • Organs
  • Congenital
  • Others
Midline structures
  • Symphysis menti
  • Hyoid bone
  • Thyrohyoid membrane (C3-C4)
  • Thyroid cartilage
  • Cricothyroid membrane
  • Cricoids cartilage (C6)
  • Trachial rings
  • Space of Burns’ “suprasternal notch”
The commonest swellings of the neck
  • Lymph nodes
  • Thyroid swelling
Midline swellings
  • Submental lymph nodes
  • Subhyoid bursa
  • Thyroglossal cyst
  • Prelaryngeal lymoh nodes
  • Laryngocele
  • Trachiocele
  • Dermoid cysts
  • Pretracheal lymph nodes
  • Swellings from suprasternal notch
    • Aneurysm
    • Lymphoma
    • Cold abscess
Posterior triangle
  • Skin lesion
  • Lymph nodes
    • Cold abscess
    • Cystic hygroma
  • Subclavian artery aneurysms
  • Neurofibroma (very specific to this area)
  • Cervical rib
  • Apex of the lung
    • Pneumatocele
    • Pancost tumor
  • Pharyngeal pouch
Submandibular triangle
  • Skin and subcutaneous lesions
  • Lymph nodes
  • Salivary glands
    • Submandibular gland
    • Lower part of parotid gland
    • Ranula
  • Lodwig’s angina
Submandibular gland swelling vs. Submandibular triangle LN

Submandibular gland swelling

Submandibular triangle lymph node enlargmant

Solitary Multiple
Felt from inside and outside the mouth Felt from outside the mouth
Not rolled on the mandible Rolled on the mandible
Increase in size with eating Have no relation with eating
Carotid triangle swellings
  • Skin and subcutaneous lesions
  • Lymph nodes
  • Branchial cyst
  • Carotid body tumor
  • Carotid aneurysms
  • Tortuous carotid artery
  • Upper pole of thyroid gland
  • Neurofibroma
Early life swellings
  • Sternomastoid tumor
  • Cystic hygroma

Summery

Neck Swellings
Neck Swellings