D.D of Mid-Line Neck Swellings
D.D of Mid-Line Neck Swellings
D.D of Mid-Line Neck Swellings
Faculty of Medicine
General Surgery
Department
D.D of Mid-line Neck Swellings
ILOs
Types;
Sequestration dermoid cyst
Inclusion demoid cyst; it happens due to inclusion of epidermis during
closure of cavity under it
Tubulodermoid; it is from distention of remnants of embryonic ducts.
Implantation dermoid; it is secondary to puncture wound which displace
some epithelial cells into subcutaneous tissue forming cyst
Painless cystic swelling in mid line, child 6-8y, once infected it will be painful,
Treatment; excision
Dermoid Cyst
Laryngeocele
Def; air sac communicating with the cavity of the larynx which may
bulge outward on the neck, may be congenital or acquired in glass
blowers and singers.
Aetiology; herniation of laryngeal mucosa through thyroid membrane
due to increase intra-laryngeal pressure.
Clinically; hoarseness, stridor, midline cystic compressible resonant
swelling give expansile impulse on cough
Investigation; X-ray, CT, laryngeoscopy
Treatment;
Laryngoscopy with CO2 laser in internal type
External excision in external type
Laryngeocele
Normal anatomy Laryngeocele
Laryngeocele
X-ray CT Laryngeoscopy
Cold Abscess
Aetiology; TB
Complication of TB infection
Neither cold nor abscess
May rupture or get infected
Management: aspiration and anti- TB drugs
Cervical Lymph nodes
Cervical Lymph nodes
Mid-line Lymphadenopathy
Sub-mental, pre-tracheal & pre-laryngeal L.Ns enlargement
Aetiology;
Inflammatory; Acute (Pyogenic infections, Infectious mononucleosis,
Toxoplasmosis, Infected eczema, CMV), Chronic (TB, Sarcoidosis, Syphilis,
HIV)
Neoplastic; Primary (Hodgkins lymphoma, Non-Hodgkins lymphoma),
Secondary (Tip tongue & lip cancer, Nasopharngeal, Thyroid, Lung, Breast,
Stomach (“Troisier’s sign”)
Clinically;
Inflammatory; swelling is painful, firm, mobile, signs of inflammation
Neoplastic; swelling is painless, hard, may be fixed, signs of primary cancer
Thyroid isthmus swellings
Individual isthmus lumps can occur in the thyroid due to:
Colloid nodules
Benign hyperplastic nodules
Thyroid adenomas
Thyroid cancer
Thyroid cyst (simple cyst, or degenerative cystadenoma)
Clinically;
Mid line swelling move up & down with swallowing at the
anatomical site of thyroid gland
Thyroid isthmus swellings
Quiz
How to approach a case of mid-line neck swellings?
Enumerate cystic & solid mid-line neck swellings
Describe thyroglossal cyst
Describe dermoid cyst
Differentiate between thyroglossal & dermoid cyst
Describe laryngeocle
Enumerate the mid-line lymph node groups of the
neck
How to differentiate the mid-line neck swellings?
THANK YOU