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Neck Masses Mohammed Mazhar Beddawi Raed Zakaria Al Bog Ahmmed Zaid Al Sabag
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Some pearls: 90% of adult neck masses are malignant 90% of pediatric neck masses are infectious in nature Know your anatomy then develop a differential diagnosis Close observation Generally, one course of a broad spectrum antibiotic is acceptable then …..
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It is never wrong to refer to a specialist for evaluation and probable biopsy Imaging is important but tissue is everything If you don’t get an answer with a FNA, repeat it up to three times. Consider ultrasound guided or CT guided FNA. REMEMBER
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HISTORY Age Duration Acute symptoms Recent travel Trauma Insect bites, pets Tobacco, alcohol, XRT
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CONGENITAL Central neck: Thyroglossal duct cysts Pyramidal lobe of thyroid Sebaceous cysts Hemangiomas Laryngocele Ectopic thyroid Lateral neck: Branchial cleft cysts Cystic hygromas Dermoids
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Thyroglossal duct cyst
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Branchial cleft cyst
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Branchial cleft cysts
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Branchial cleft cyst
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Inflammation Reactive lymphadenopathy Sialoadenitis Cervical adenitis
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Infectious Staph and strep EBV – mono TB HIV Cat scratch fever (Bartonella henselae) Toxoplasmosis Actinomycosis Tick-borne: Rocky Mountain Spotted Fever Lemierre’s Syndrome: septic thromb. IJV
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Trauma Hematoma Acute and expanding Chronic and organizing AV fistula Pseudoaneurysm
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Metabolic, Idiopathic, Autoimmune Castleman’s disease Sarcoidosis Kimura’s disease
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Neoplasms Benign: Lipomas Neuromas Fibromas Hemangiomas Carotid body tumors Angiomas
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Neoplasms Malignant Thyroid Squamous cell carcinoma (SCCA) Lymphoma Sarcoma Salivary gland tumors Metastasis: SCCA, adenocarcinoma, undifferentiated carcinoma, melanoma
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Management 1 course of broad spectrum antibiotics Consider bloodwork and imaging REFERAL
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Pearls Avoid excisional biopsies Use CT but consider MRI for salivary gland problems Role of ultrasound
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THYROID
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Evaluations of Nodular Thyroid Disease History- symptoms, duration, familial Physical findings, i.e. topography, firmness, surface, lymphadenopathy Thyroid functions tests- TFT (s) - TSH
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Diagnostic Studies- Thyroid Cancer Fine Needle Aspiration- Establishes Cytologic Diagnosis Thyroid function tests Technetium Scan- reflects trapping function, “hot nodule” Ultrasonography- reflects volume, composition, occult nodules
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Thyroid Cancer- Diagnosis Cytology Scans Technetium Radioiodine Sestamibi MR/CT/PET Ultrasound Frozen Sections Fixed Sections
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Thyroid Cancers* Papillary80% Follicular11% Hürthle3% Medullary4% Anaplastic2%
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Papillary Carcinoma (Age, Distant Metastases, Extent, Size) AMES
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Thank You
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