Paediatric-History taking & Physical examination of anterior neck swellingCreated OnApril 29, 2020Last Updated OnApril 29, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of anterior neck swelling < All Topics Table of Contents History taking: Ask about patient’s details: Name, age, gender Ask about chief complaint and history of presenting illness Onset Mass present at birth: benign & developmental Vascular malformation: present at birth Hemangioma: develop few weeks after birth Mass How was mass first noticed? Size Shape Discharge or blood? Rate of enlargement? – rapid enlargement within a short period of time is alarming for malignancy Location Midline: thyroglossal cyst, dermoid cyst, thyroid cancer Lateral: brachial cyst, vascular or lymphatic malformation, lymphadenopathy Duration Mass persisting >6 weeks (red flag) Associated symptoms Fever, rapidly enlarging, painful, redness: inflammatory Constitutional B symptoms: fever, malaise, weight loss, night sweat → lymphoma Bilateral conjunctivitis, rash, edema of hands and feet, mucosal involvement: Kawasaki disease Hyperthyroidism: irritability, weight loss despite good appetite, sweating, heat intolerance, increased bowel movements Recent URTI, sick contact, TB contact, cat scratch Ask about family history Any family hx of malignancy Ask about drug history Use of drugs that can cause lymphadenopathy (eg. phenytoin, quinidine, isoniazid, gold, carbamazepine) Ask about travel history Travel to TB endemic countries Physical examination: General Vital signs: pulse, BP, respiratory rate, temperature General appearance: Cachexic looking (malignancy) Thin build, anxious, sweating, warm moist palms, tremors, resting tachycardia (hyperthyroidism) Look for bilateral conjunctivitis, rashes, edema of hands and feet, mucosal involvement (strawberry tongue, fissures) – Kawasaki disease Examination of mass Site Midline: thyroglossal cyst, thyroid, dermoid cyst Lateral neck: LN (inflammatory/ neoplastic), brachial cyst Size Shape Butterfly shape: goiter Round: thyroglossal cyst, solitary thyroid nodule, dermoid cyst, LN, brachial cyst Surface Skin changes: erythematous (reactive lymphadenopathy, lympadenitis) Mass moves upon protrusion of tongue and deglutition (thyroglossal cyst) Mass moves with deglutition only (thyroid gland) Temperature: warm in inflammatory neck mass (infected cyst, lymphadenitis) Palpate using the dorsal surface of the hand Fluctuant in suppurative lymphadenitis (associated with warm, erythema, tenderness) The lump is fixed by a compressing hand, pressure is applied by the testing finger. Fingers of the compressing hand pushed apart → fluctuation positive Tenderness: Tender: lymphadenitis, reactive lymphadenopathy, brachial cyst, infected cyst Painless: thyroglossal cyst, dermoid cyst, thyroid, lymphoma Mobility: suspect malignancy if fixed Fixity to skin Pulsation Expansile pulsation (swelling arises from arteries) à finger move outwards Transmitted pulsation (swelling arises from arterial walls) → fingers move upwards Consistency Rubbery: lymph node Hard: suspect malignancy Compressibility Examination of other systems Supraclavicular mass: GI malignancy Respiratory system Ear, nose, throat Taken from Doctrina Perpetua guides on Paediatric
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