颈部肿块的评价及处理（英文）

小米

TITLE: Evaluation and Management of the patient with a neck mass

"This material was prepared by resident physicians in partial fulfillment of educational requirements established for the Postgraduate Training Program of the UTMB Department of Otolaryngology/Head and Neck Surgery and was not intended for clinical use in its present form. It was prepared for the purpose of stimulating group discussion in a conference setting. No warranties, either express or implied, are made with respect to its accuracy, completeness, or timeliness. The material does not necessarily reflect the current or past opinions of members of the UTMB faculty and should not be used for purposes of diagnosis or treatment without consulting appropriate literature sources and informed professional opinion."
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Introduction

        A mass in the neck is a common clinical finding that presents in patients of all age groups.  The differential diagnosis may be extremely broad, and although most masses are due to benign processes,  malignant disease must not be overlooked.  Therefore, it is important for physicians to develop a systematic approach for developing a working diagnosis and management plan for the patient.

Anatomy

        The prominent landmarks of the neck are the hyoid bone, thyroid cartilage, cricoid cartilage, trachea, and sternocleidomastoid muscles.  In females, the cricoid cartilage is often the most palpable laryngeal structure, whereas in men, the thyroid cartilage is most easily palpable.  The SCM divides each side of the neck into two major triangles, anterior and posterior.  The anterior triangle is delineated by the anterior border of the SCM laterally, the midline medially, and the lower border of the mandible superiorly.   The anterior triangle can be further divided into the inferior carotid (muscular), superior carotid, submandibular and submental triangles. The borders of the posterior triangles are the posterior border of the SCM anteriorly, the clavicle inferiorly, and the anterior border of the trapezius muscle posteriorly.  The omohyoid muscle divides this triangle into the subclavian and occipital triangles.   The floor of the posterior triangle is formed by the splenius capitus, levator scapulae and scalene muscles.

程觉

学习了，谢谢分享，辛苦了！

锦心素颜

谢谢分享！辛苦啦！

rainsnowly

感谢分享

甜甜的麦芽糖

谢谢分享，辛苦了

dongsheng_gu

entcyh2010

不错，能解释了一些颈部肿物的信息，谢谢。

小鹤

是英文原版的么 还是自己翻译的
AXC0

小米

Summary

        The differential diagnosis of neck masses is extensive and varies with the age of the patient at presentation.  A thorough work-up including an accurate history and complete head and neck examination often narrows the diagnostic possibilities, thus obviating the need for excessive testing and invasive procedures.  The fine needle aspiration biopsy has become an invaluable tool to aid clinicians in the evaluation of the neck mass and is safe, accurate, and cost-effective with minimal complications.  The possibility of malignancy in any age group, especially in the late adult group, should never be overlooked.  Close follow-up and aggressive pursuit of a diagnosis with appropriate work-up facilitates a timely and accurate treatment plan, which is essential to a favorable outcome.

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are compressible.  CT or MRI again help the diagnosis and define the extent of disease.  Surgical treatment is reserved for lesions with rapid growth, associated thrombocytopenia or involvement of vital structures that fail medical therapy (steroids, interferon).


Inflammatory Disorders

Lymphadenitis

        Acute lymphadenitis is very common at some point in almost everyone’s life, especially during the first decade.  The presentation with marked tenderness, torticollis, trismus and dysphagia with systemic signs of infection is seldom a diagnostic challenge to the clinician and the source of the reactive lymphadenopathy is usually easily identified.  Initial treatment with directed antibiotic therapy and follow up is the rule.  

        Inflammatory nodes generally regress in size.  If the lesion does not respond to conventional antibiotics a biopsy is indicated after complete head and neck work-up.  Other indications for FNAB of lymphadenopathy include progressively enlarging nodes, a solitary and asymmetric nodal mass, supraclavicular mass or persistent nodal masses without active infectious signs.  Equivocal or suspicious FNAB in the pediatric nodal mass requires an open excisional  biopsy to rule out lymphoma or granulomatous disease.

Granulomatous lymphadenitis

        These infections usually develop over weeks and months, often with minimal systemic complaints of findings.  They may be the result of typical or atypical mycobacteria, actinomycosis, sarcoidosis, or cat-scratch fever (Bartonella).  The glands tend to be firm, with some degree of fixation and injection of the overlying skin.  They may suppurate and drain only to reform.  Tuberculosis is now rarely seen in our population and is more common in adults within the posterior triangle.  Atypical mycobacteria and cat-scratch fever are more common and more prevalent in the pediatric age group.  Atypical mycobacterial infection usually involves anterior triangle lymph nodes often with brawny skin, induration and pain, while cat-scratch commonly involves the preauricular or submandibular nodes.  Typical TB lymphadenitis often responds to anti-tuberculosis medications.  Cat-scratch often undergoes spontaneous resolution with or without antibiotic treatment.  Atypical mycobacterial infection usually responds to complete surgical excision.