Anatomy helpful in determining etiology
Anterior and posterior cervical triangles divided by SCM
Associated symptoms based on etiology:
Pain
Skin changes
Stridor
Hoarseness
Fever
URI symptoms
Weight loss/night sweats
Important to distinguish chronicity
Anterior and posterior cervical triangles divided by SCM
Pain
Skin changes
Stridor
Hoarseness
Fever
URI symptoms
Weight loss/night sweats
Assess for chronicity, associated symptoms, exposures (cats, undercook meat)
Physical Examination
Benign reactive lymph nodes
Mobile, firm, and mildly tender
Clinical diagnosis
Lymphadenitis/suppurative disease
Painful, erythema, possibly fluctuant
Clinical diagnosis
CT imaging if concerns for deep space infection: trismus, torticollis, stridor, drooling
Extrapulmonary form of mycobacterium tuberculosis (cervical adenopathy)
Multiple bilateral lymph nodes
Fixed, firm, non-tender, located typically in posterior triangle
Cystic<unk> es
Soft, mobile, ballotable
Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
Branchial cleft cyst: lateral, mandibular angle anterior to SCM
Dermoid cyst: submental triangle
Malignant lesions
Hard, non-tender, and possible immobile
Sialoadenitis
Tenderness to affected salivary gland and pus at the duct orifice
Parotid gland- stensen duct
Submandibular gland- wharton duct
Benign reactive lymph nodes
Mobile, firm, and mildly tender
Clinical diagnosis
Lymphadenitis/suppurative disease
Painful, erythema, possibly fluctuant
Clinical diagnosis
CT imaging if concerns for deep space infection: trismus, torticollis, stridor, drooling
Extrapulmonary form of mycobacterium tuberculosis (cervical adenopathy)
Multiple bilateral lymph nodes
Fixed, firm, non-tender, located typically in posterior triangle
Cystic<unk> es
Soft, mobile, ballotable
Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
Branchial cleft cyst: lateral, mandibular angle anterior to SCM
Dermoid cyst: submental triangle
Malignant lesions
Hard, non-tender, and possible immobile
Mobile, firm, and mildly tender
Clinical diagnosis
Painful, erythema, possibly fluctuant
Clinical diagnosis
CT imaging if concerns for deep space infection: trismus, torticollis, stridor, drooling
Multiple bilateral lymph nodes
Fixed, firm, non-tender, located typically in posterior triangle
Soft, mobile, ballotable
Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
Branchial cleft cyst: lateral, mandibular angle anterior to SCM
Dermoid cyst: submental triangle
Hard, non-tender, and possible immobile
Tenderness to affected salivary gland and pus at the duct orifice
Parotid gland- stensen duct
Submandibular gland- wharton duct
Parotid gland- stensen duct
Submandibular gland- wharton duct
Neck mass
Reactive lymphadenopathy- most common
Neck pain
Viral URI
Widened mediastinum
EBV
Chest wall pain
CMV