Diagnostic Tests for Neck swelling

Diagnostic Test list for Neck swelling:

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Neck swelling includes:

• Physical examination
  • Pulse rate. If elevated must consider Grave's disease, subacute thyroiditis or early Hashimoto's thyroiditis
  • Look for signs of hyperthyroidism including agitation, restlessness, enlarged thyroid (goiter), warm and sweaty palms, fine tremor, protruding eyes. May suggest Grave's disease, subacute thyroiditis or early Hashimoto's thyroiditis
  • Examine for signs of hypothyroidism - e.g. slow heart rate, slowed reflexes, coarse dry brittle hair, dry cool skin, goiter.
  • Watch neck lump when swallowing. If the lump moves with swallowing this would suggest thyroid lump or thyroglossal cyst
  • Feel neck swelling to determine if neck swelling is localized or diffuse (generalized neck swelling). Localised neck masses or swellings may be thyroglossal cysts, branchial cleft cyst, aneurysm, an enlarged lymph node due to Hodgkin's disease, metastatic cancer, sarcoidosis, a cystic hygroma, carotid body tumor, Reidel's struma, thyroid benign tumors or malignant thyroid cancer. Diffuse swellings would be Graves disease, subacute thyroiditis, superior vena cava syndrome, non-toxic goiter, venous distention of congestive heart failure or superior vena cava syndrome and subcutaneous emphysema
  • Determine if neck swelling is midline or lateral (to the side) to the midline. Midline swellings are thyroglossal cysts, adenoma of the thyroid, Reidel's struma and thyroid cyst. Lateral swellings include a pharyngeal pouch, bronchial cyst, pulsion diverticulum, stone of Wharton's duct, Virchow's node, cervical rib, metastatic lymph nodes or Hodgkin's lymphoma, metastatic cancer, cystic hygroma, carotid body tumor and some thyroid masses
  • Feel all neck lymph nodes for enlargement - The causes of enlarged cervical lymph nodes include infection (e.g. tonsillitis, glandular fever, toxoplasmosis, tuberculosis, cat scratch fever), metastatic tumor (from head, neck, chest or abdomen), primary cancer (lymphoma, lymphosarcoma) and sarcoidosis.
  • Feel for enlarged supraclavicular lymph nodes (just above the collar bone)? - must consider lung cancer, cancer of the gastrointestinal tract, infections of the neck, arm, larynx or thyroid.
  • Examine ears, nose and throat
  • Feel for crepitus (crackling sensation felt on feeling the skin of the chest or neck) which is present in subcutaneous emphysema. It is caused by air tracking from the lungs and is usually due to a pneumothorax and less commonly it can follow rupture of the esophagus
  • Cardiovascular examination looking for enlarged heart which may suggest congestive cardiac failure
• Blood tests
  • Full blood count and ESR
  • Electrolytes
  • Thyroid function tests
• Mantoux test, if suspect tuberculous cervical lymphadenitis or abscess
• Urine tests
  • Urinalysis
• Radiological investigations
  • Chest X-Ray may help diagnose generalized lymph node enlargement and lung cancer
  • Echocardiogram
  • Radioactive iodine uptake and scan will help differentiate thyroid tumors and enlargements
  • Neck ultrasound scan will help differentiate benign thyroid cysts
  • Angiography will be useful in diagnosing aortic aneurysms, innominate aneurysms and subclavian aneurysms
  • CT Scan of the chest cavity will help diagnose superior cava syndrome
• Needle aspiration of thyroid cyst
• Lymph node biopsy - will be useful in diagnosing sarcoidosis, lymphomas and metastatic cancer.
• Electrocardiogram (ECG)
• Pulmonary function tests - will help differentiate congestive cardiac failure.
• Esophagogram - will help detect Zenker's diverticulum (a pouch opening from the esophagus).
• Bone marrow examination - may help identify lymphoma.

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