Evaluation of the neck : Positioning, inspection, Palpation, Investigations

February 20, 2013 | By | Reply More

Evaluation of the neck : Positioning, inspection, Palpation, Investigations

Positioning and inspection
  • Sit the patient upright at rest with the head looking straight ahead. Inspect the neck from the front, side, and, if necessary, behind.
  • Observe the neck at rest and during swallowing (a glass of water). If necessary inspect rotation left and right.
  • Observe the neck while asking the patient to protrude the tongue.
Inspection includes looking for the following.
  • Overall symmetry and lumps. Are there obvious lumps? Are they single or multiple? Is the lump lying in or close to the midline? Does the lump move with swallowing (suggests thyroid-related lesion)?
  • Skin abnormalities. Are there any ulcers of sinuses (suggests chronic infection such as TB)?
  • Associated structures. Is there evidence of venous engorgement or collateral vessels visible?
Palpation
Be systematic; palpate the regions of the neck in order. Use both hands with the flats of the fingers to compare each side but move only one hand at once to prevent ‘cross-palpation’. A typical sequence of palpation is: anterior triangle (bottom to top); submental area; submandibular area; posterior triangle (top to bottom); supraclavicular fossae. Repalpate the neck with the patient swallowing a mouthful of water—particularly the anterior triangle . Lastly feel specifically for the carotid arteries.
  • Lumps. Is it single or multiple (multiple strongly suggests lymphadenopathy)? Is it strictly in the midline (likely to be related to the thyroid)? Does it move with swallowing (almost always thyroid-related)? What are the general features ?
  • Thyroid lumps. Is it unilateral or bilateral? Does it move with tongue protrusion?
  • Carotid arteries. Are they normal, ecstatic, or aneurysmal?
  • Supraclavicular fossae. Is there associated lymphadenopathy (suggests malignancy)?
Auscultation
Listen to the carotid arteries and any large masses for bruits suggesting a hypervascular local circulation or stenosis.
Investigations
Ultrasound
  • Easy to perform and painless.
  • Avoids radiation dose.
  • Highly sensitive for the differentiation between solid tumours and cysts.
Aspiration cytology
  • Easy to perform and quick to report on—often done in one half day during outpatients.
  • Almost painless.
  • Provides only cellular information and relies upon cellular atypia for a diagnosis of malignancy.
  • Does not provide histological information.
  • Occasionally therapeutic for cysts.
  • Good sensitivity and specificity.
  • Contraindicated where there is a suspicion the lesion may be vascular.
CT scanning
  • Useful for assessment of extensive local invasion and regional and systemic staging of tumours.
  • Allows evaluation of the thorax in some thyroid tumours.
MRI scanning
  • Useful for detailed assessment of local invasion of tumours.

 

Category: Surgery

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