Neck Swellings: Causes, Types, and Differential Diagnosis

Discuss the differential diagnosis of swelling in the lateral aspect of neck.

Answer. It is classified according to their location in three triangles of the neck:

1.Submandibular or digastric triangle

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2. Carotid triangle

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3.In posterior triangle

Solid swellings:

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Cystic swellings:

Pulsatile swellings:

Sub-mandibular or digastric triangle

Enlarged Sub-mandibular lymph node

They form a nodular swelling which is deep to deep fascia.

They are palpable only in the neck.

The nodes can get enlarged due to following conditions:

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Acute lymphadenitis: Very often, poor oral hygiene or a caries tooth produces painful, tender, soft enlargement of these lymph nodes. Extraction of the tooth or with improvement of oral hygiene, lymph nodes regress.
Chronic tuberculous lymphadenitis can affct these nodes along with upper deep cervical nodes.
The nodes are fim and matted.
Secondaries in the submandibular lymph nodes arise from carcinoma of the cheek, tongue, and palate.
The nodes are hard with or without fifty.
Non-Hodgkin’s lymphoma can involve submandibular lymph nodes along with horizontal group of nodes in the neck.
The nodes are fim or rubbery in consistency.

Submandibular Salivary Gland enlargement

The common causes are chronic sialadenitis with or without a stone, tumors of the salivary gland or enlargement due to autoimmune diseases.

They form irregular or nodular swelling.

The diagnosis is confimed by bidigital palpation of the gland.

Enlarged submandibular gland is bidigitally palpable because the deep lobe is deep to mylohyoid muscle.

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Carotid triangle

Branchial cyst: It is located in anterior triangle of neck.
It is soft, cystic, fluctuant, and transillumination negative.
Lymph node swelling (Cold abscess): Patient present with history of tuberculosis. Lymph nodes are fim and mattd.
Signs of inflmmation are absent.
Aneurysm of carotid artery: It is fim, flctuant and transillumination negative swelling with presence of expansile pulsations. Bruit/thrill can be heard.
Carotid body tumor: It is has a typical location, i.e. located at level of hyoid bone in upper part of anterior triangle of neck beneath anterior edge of sternomastoid muscle.
On palpation it moves in transverse direction. Surface is smooth or lobulated, borders are round, oval in shape,vertically placed swelling.
Sternomastoid tumor: Swelling is present in infants or children.
It is tender, mobile sideways, medial and lateral borders are distinct.
Both superior and inferior borders are continuous with the swelling.
Laryngocele: It is a smooth, oval, boggy swelling which moves upwards on swallowing.
Expansile cough impulse is present.
Neurofibroma of vagus nerve: It produces swelling in carotid triangle in region of thyroid swelling.
It is a vertically placed oval swelling.
On pressure over the swelling dry cough occurs and in some cases bradycardia can occur.

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Posterior triangle

Solid Swellings

Metastasis in lymph nodes: Lymph nodes become enlarged and become fied to the underlying structures.
They become immobile and are stoney hard in consistency.
Tuberculosis: Lymph nodes become enlarged mainly cervical. The nodes are fim and mattd.
Lymphoma: It can involve submandibular lymph nodes along with horizontal group of nodes in the neck. The nodes are fim or rubbery in consistency.
Lipoma: It is a localized swelling with lobular surface,non-tender. It is semiflctuant and non-transilluminant. It is mobile with edges slipping between palpating figers.
Cervical rib: It is an extra, rib present in the neck. A hard mass is visible or palpated in root of neck.
Pancoast tumor: It is a tumor felt in the lower part of posterior triangle. It is hard in consistency, fied, irregular
and sometimes tender. Lower border of mass cannot be appreciated.

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Cystic Swellings

Lymphangioma: Skin vesicles contain watery or yellow flid. Bleeding in vesicle turn into brown or black.
Area is soft, spongy, often flctuant with flid thrill and translucency. It is non-compressible.
Vesicles will not fade on pressure.
Hemangioma: Swelling is warm and bluish in color, nonpulsatile, soft, flctuant, transillumination negative.
Compressibility is present.
When the swelling is compressed between figers blood diffuses under vascular spaces and when pressure is released it slowly fills up.
Cold abscess: The patient present with history of tuberculosis.
Lymph nodes are fim and mattd. Signs of inflmmation are absent.

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