Indeed, ultrasound findings alone can be sufficient to make a diagnosis of certain neck lumps. Ultrasound provides characterisation of lymph nodes, salivary glands, vascular structures, and thyroid nodules. The first-line investigation for a suspicious neck lump is ultrasound +/- fine needle aspiration (FNA). Figure 1 - (A) Lateral neck lump caused by cervical lymphadenopathy (B) Central neck lump caused by thyroid goitre Investigation As such, an u ltrasound-guided FNA is an important investigation prior to arranging for excision of the mass. Sclerotherapy can be offered as an alternative to surgery in certain cases, involving injection of a sclerosing agent under ultrasound guidance.Ĭare needs to be taken when managing these patients as a common differential diagnosis is a cystic metastasis from a squamous cell carcinoma of the head and neck region. Surgical excision is the definitive treatment. Larger branchial cysts can result in dysphagia, dysphonia, and difficulty breathing. When infected, they can increase in size and become painful. They present as palpable masses anterior to SCM, typically unilateral (Fig.
Incomplete obliteration of these clefts will result in the formation of branchial cysts.
*In rare cases (~1%), patients may develop thyroglossal duct cyst carcinoma that often arises from ectopic thyroid tissue in the cyst (the most common histology is papillary carcinoma)īranchial cysts are congenital masses which arise in the lateral aspect of the neck, typically anterior to the sternocleidomastoid (SCM).ĭuring the fourth week of development, branchial clefts form ridges known as branchial arches, involved in the formation of a number of structures in the head and neck. There is a high chance of recurrence if the medial portion of the hyoid bone is not removed. The central body of the hyoid bone is removed to allow complete removal of the entire thyroglossal tract. Standard treatment is surgical intervention, with the Sistrunk procedure being the most widely used. 5A) that move up with protrusion of the tongue. Thyroglossal cysts present as a palpable painless midline mass* (Fig. In normal development, this duct will obliterate, however thyroglossal cysts occur when portions of this duct remain patent, creating cavities that may fill with fluid and being prone to infection. During embryonic development, the thyroid gland originates from the base of the tongue (foramen caecum), migrating down to its final position in the neck and connecting back to the tongue via the thyroglossal duct.