Examination of Neck Swelling
Boundaries and Triangles of the Neck
- The neck is bounded by the following structures:
- Superiorly by the jaw
- Inferiorly by the clavicles
- Anteriorly by the sternum
- Posteriorly by the vertebral column
- The neck is divided into triangles:
- Delphian triangle (above and anterior to the thyroid cartilage)
- Submandibular triangle (below the mandible and anterior to the sternocleidomastoid muscle)
- Digastric triangle (below the mandible and posterior to the sternocleidomastoid muscle)
- Carotid sinus triangle (anterior to the carotid artery and internal jugular vein)
- Danger triangle (below the cricoid cartilage and posterior to the sternocleidomastoid muscle)
Important Anatomical Landmarks of the Neck
- Adam's apple (laryngeal prominence)
- Thyroid cartilage
- Trachea
- Esophagus
- Carotid artery and internal jugular vein
- Sternocleidomastoid muscle
- Submandibular gland
- Parotid gland
- Spinal accessory nerve
Classification of Neck Swellings
- Midline Neck Swellings: thyroid swelling, laryngeal swelling, tracheal swelling
- Lateral Neck Swellings: lymphadenopathy, salivary gland swelling, submandibular gland swelling
- Cervical masses: thyroglossal duct cyst, branchial cleft cyst, dermoid cyst
Obtaining Detailed History of Neck Swelling
- Onset: sudden or gradual
- Duration: acute or chronic
- Progression: worsening or improving
- Associated local symptoms: pain, discomfort, difficulty swallowing
- Systemic symptoms: fever, weight loss, fatigue
Physical Examination of Neck Swelling
- Inspection: observe the swelling, note its size, shape, and color
- Palpation: feel the swelling, note its consistency and tenderness
- Auscultation: listen to the swelling, note any abnormal sounds
- Examine lymph nodes: note their size, shape, and tenderness
- Examine thyroid gland: note its size, shape, and tenderness
- Examine other neck structures: note any abnormalities
Examination of Lymph Nodes
- Cervical lymph nodes: note their size, shape, and tenderness
- Axillary lymph nodes: note their size, shape, and tenderness
- Groin lymph nodes: note their size, shape, and tenderness
Examination of Thyroid Gland
- Thyroid swelling: note its size, shape, and tenderness
- Thyroid nodules: note their size, shape, and tenderness
- Thyroiditis: note its severity and duration
Examination of Other Neck Structures
- Carotid artery and internal jugular vein: note any abnormalities
- Trachea: note any abnormalities
- Esophagus: note any abnormalities
- Submandibular gland: note any abnormalities
- Parotid gland: note any abnormalities
Correlating Clinical Findings with Causes
- Inflammatory lymphadenopathy: fever, pain, swelling, redness
- Thyroid swellings: difficulty swallowing, hoarseness, shortness of breath
- Neoplastic lesions: pain, swelling, difficulty swallowing, hoarseness
Pathology and Treatment of Neck Swelling
- Inflammatory lymphadenopathy:
- Causes: bacterial or viral infection
- Clinical features: fever, pain, swelling, redness
- Investigations: lymph node biopsy, blood tests
- Complications: abscess formation, sepsis
- Management: antibiotics, drainage of abscess
- Thyroid swellings:
- Causes: thyroiditis, goiter, thyroid cancer
- Clinical features: difficulty swallowing, hoarseness, shortness of breath
- Investigations: thyroid function tests, ultrasound, biopsy
- Complications: respiratory distress, cardiac failure
- Management: thyroid surgery, radioactive iodine ablation
- Neoplastic lesions:
- Causes: lymphoma, thyroid cancer, salivary gland cancer
- Clinical features: pain, swelling, difficulty swallowing, hoarseness
- Investigations: lymph node biopsy, blood tests, imaging studies
- Complications: metastasis, respiratory distress, cardiac failure
- Management: chemotherapy, radiation therapy, surgery