neck masses and salivary glands HEENT

HIV parotitis S&S

nonpainful swelling of parotic gland or asymptomatic

parotitis in TB S&S

chronic nontender swelling of one parotid glands, lump within gland

uncommon

sjogren syndrome S&S

recurrent or chronic swelling of one or both parotid glands

discomfort is modest, dry mouth and eyes

associated with autoimmune

what’s the major salivary glands possibly involved in salivary gland stones (sialolithiasis)

parotid/stensen’s duct

submandibular/wharton’s duct

sublingual

salivary gland stones (sialolithiasis)

inflammation of salivary gland/duct

stagnation of salivary flow and Ca conc.

pathogenesis unknown

which gland is more prone to stone formation and why?

submandibular gland, flow of saliva is slow and against gravtiy

sialolithiasis S&S

sudden onset of swelling and pain in affected gland assoc. w/ eating and anticipation of eating

sialolithiasis Dx

clinical, history and PEx

sialolithiasis imaging?

CT w/o contrast for location of stone

solid = malignancy?, cystic = benign? (fluid, soft)

sialolithiasis Tx

conservative management - hydration, moist heat, massage gland

supportive: discontinue anticholinergic meds, NSAIDs PRN

complications of sialolithiasis

acute bacterial sialadenitis, abscess formation

acute bacterial sialadenitis

suppurative sialadenitis that can occur in absence of stone

most commonly involved gland in acute bacterial sialadenitis

parotid gland

most common pathogen in acute bacterial sialadenitis?

staph aureus

acute bacterial sialadenitis S&S

increased pain and swelling with meals

tenderness and erythema of duct opening

+pus = infxn

acute bacterial sialadenitis Tx

PO Abx

viral sialadenitis/viral parotitis - most common cause

mumps virus

viral sialadenitis (mumps) S&S

acute pain and swelling of one or both parotid glands

low-grade fever, malaise, HA, myalgia, anorexia

Tx of mumps/viral sialadenitis

self-limiting, supportive care

what is the most common type of benign salivary gland tumors?

pleomorphic adenoma

what is the most frequent site of salivary gland tumors?

parotid gland

what is the most common malignant salivary gland tumor?

mucoepidermoid carcinoma and adenoid cystic carcinoma

S&S salivary gland tumors

painless mass/swelling of the major glands

salivary gland tumor = parotid mass (+) is indicative of what?

facial nerve involvement, usually malignant

salivary gland tumor Dx

CT vs. MRI,

FNA bx, US Core Bx for definitive Dx

lyme disease bacteria

borrelia burgdorferi

what is lyme disease transmitted by?

Ixodes genus ticks

S&S lyme disease

facial paralysis, dysesthesias (decreased sensation CNVII), dysgeusia

HA, pain, cervical lymphaenopathy

cat scratch disease bacteria

Rochalimaea henselae (gram negative rod)

cat scratch disease S&S

cat scratch or bite, local papule/pustule/vesicle overlying scratch

persistent painful regional lymphadenopathy

cat scratch disease Dx

lab - skin test with antigen (Hanger-Rose skin test)

what is the most common form of congenital cyst in the neck?

thyroglossal duct cyst

thyroglossal duct cyst S&S

midline neck mass at level of thyrohyoid membrane, associated w hyoid bone

sinus tract may be present

thyroglossal duct cyst Dx

CT/MRI/US, fistulography

FNA - definitive Dx

thyroglossal duct cyst Tx

surgical excision

branchial cleft cyst/fistula

congenital epithelial cysts in lateral part of the neck

branchial cleft cyst S&S

swelling in upper part of neck to SCM muscle,

± fistula to surface

branchial cleft cyst Tx

conservative vs. surgical excision

dermatoid cyst caused by

entrapment of epithelium in deeper tissue

dermoid cyst S&S

usually midline, nontender, mobile, submental neck masses

dermoid cyst Tx

surgical excision

lymphangioma

congenital malformation of lymphatic system

lymphangioma Tx

surgery, sclerotherapy, laser therapy

congenital torticollis

postural deformity of neck (lateral neck flexion and neck rotation)

contracted muscle appears like a mass

goals of congenital torticollis Tx

midline head position, posture symmetric, craniofacial symmetry improvement

teratoma

arises from pluripotential cells

classically large, encapsulated - cystic component

thymic mass

implantation of thymic tissue during embryonic descent

usually midline, angle of mandible to midline of neck

thymic mass Tx

surgical excision

which are rare causes of neck masses

metabolic and autoimmune

metabolic neck masses causes:

gout, sarcoidosis (granulomas tissue)

kimura’s disease, castleman’s disease

kimura’s disease

uncommon chronic inflammatory condition involve subcutaneous tissue

castleman’s disease

benign lymphoproliferative disorder that most frequently involves mediastinal lymph nodes

lymphoma

malignancy neck mass of lymphatic system (cancer)

what are the two types of lymphomas?

non-Hodgkins and Hodgkins

S&S lymphoma

painless swelling of lymph nodes, fatigue, SOB

B-symptoms: fever, night sweats, unexplained weight loss

lymphoma Tx

depends on: type of disease, aggressiveness, location, age, general health

Hodgkin’s lymphoma

younger usually

arise in neck, axilla, chest, Reed-Sternberg cell

non-hodgkin’s

older pts usually

arise in LN throughout body

dx at more advanced stage

which type of lymphoma has poor prognosis and why?

Non-Hodgkin’s due to delayed Dx

substernal goiter

trachea displaced