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Neck mass :necktie: (Inx :male-scientist::skin-tone-4: (U/S (Useful esp…

- - - - Any neck mass that isn’t obvious abscess
      - Persistence after 2 wks course of ATBs
    - - On anti plt/ anticoagulants
      - Coagulopathy
- - - - Cystic, not tender, uniloculated, well-circum mass
      - fluctuant mass turn into Inflamed & Abscess during URI
    - - Sup & Lat to CN IX & XII ⇨ Course between ICA & ECA
      - Fistula External opening: along anterior border of SCM
      - Internal opening: Posterior tonsillar pillar
        
        So CC could be D/C fr tonsil เป็นๆหลายๆได้
  - - - Tender nodes + Signs of Systemic infection
    - - :check: I/C
        
        Actively infectious condition with no response to ATB
        
        Progressively enlarging
        
        Solitary, asymmetric nodal mass
        
        Supraclavicular mass (60% malig)
        
        Persistent nodal mass without active infection (อารมณ์หลัง infection หายแล้วแต่ก้อนไม่ยุบ)
  - - - Sporadic case mostly
      - Most commonly between 20-50 yrs
      - Usu in Poststyloid compartment
    - - Medial tonsillar displacement
      - Hoarseness (vagus n)
      - Horner’s syndrome (Sympathetic chain)
  - - - Benign: Asymp except for mass
      - Malignant:
        
        rapid growth
        
        Skin fixation
        
        CN palsies
    - - “Open excisional biopsy (Submandibulectomy or Parotidectomy)” preferred
        tho rec ให้ทำ FNAB first as กลัว Cell ไม่พอ
    - - :star:FNAB (high accuracy as sense & spec are high)
      - CT/MRI for deep lobe tumors, Intra vs Extra parotid
        this affect Sx as look for border of mass
  - - - Lateral neck mass only which are discrete, rubbery, non tender
      - Fever
      - Hepatosplenomegaly
      - Diffuse adenopathy
      - !!! Usu present with multiple lateral neck mass along chain both sides but each mass has different size
    - - If suggest of lymphoma ⇨ Open Bx to แยก type of lymphoma
      - Full workup
        
        CT scans of Chest, Abdomen, H&N
        
        BM Bx
- - - - Fluid level is clue of Dx
      - T1 variable esp depends on protein content
      - T2 usu high signal
  - - - H&N region and m/c at Embryologic fusion lines
      - Lateral 3rd of eyebrow
      - Midline of neck
        
        Move with overlying skin & painless (unless if it’s infect — then it’s painful)
        
        Mass: firm, don’t trans illuminate (so not cyst), no pulsate, No change in size with crying or Jugular vein compression
        
        :!: most frequently found in 1/2 locations
        
        Parahyoid region — mimic thyoglossal duct cyst
        
        Submental region
        
        Suprasternal between strap ms & onto Trachea
      - Nasolabial fold
      - Nasal dermoid
  - - - Children
        
        M/C neoplastic
        
        :male_sign: predom.
        
        Higher incidence for malig
      - Adult
        
        :female_sign: predom
        
        Mostly benign
    - - Initial symptoms in 15% of papillary ca
      - 40% with malignant nodules
      - Histologically in >90%