ABSTRACT
DIFFERENTIAL DIAGNOSIS Lumps in the Neck Lymphadenopathy is the most common cause of neck swellings. Enlarged lymph nodes can be broadly classifi ed into 4 categories, infective (TB, glandular fever, tonsillitis),
metastatic (secondary deposits), lymphomas and sarcoidosis. Branchial cyst is a remnant of the ectodermal pouch from the branchial cleft. It is located beneath the upper part of the SCM and presents as a painless cyst. It is a smooth cystic, ovoid shaped lump that is 5-10 cm in diameter. It fl uctuates but does not transilluminate light and cannot be compressed or reduced. Carotid body tumour (chemodectoma) is a slowly growing painless lump. It is located at the bifurcation of the common carotid artery at the level of the upper border of the thyroid cartilage under the anterior border of the SCM muscle. It is a hard ovoid swelling that moves from side to side but not in the vertical plane. Transmitted pulsations are often present. Sternomastoid tumour is a fi rm solid swelling caused by trauma at birth. It is located at the middle third of the SCM muscle. Since the lump originates from the muscle only the anterior and posterior margins are distinct and may lead to torticollis in later life. Cystic hygroma is a swelling of the jugular lymph sac and is situated at the base of the posterior triangle. The lump is a lobulated cyst and shows brilliant translucency. Thyroglossal cyst is a cystic remnant of the thyroglossal duct that persists and is seen in early childhood. It is a hard well defi ned spherical lump that is commonly found just above the hyoid bone and in the midline of the neck. Pathognomonic characteristics include moving on swallowing as well as on protrusion of the tongue.
