NeckMass2-2001-12-slides

NeckMass2-2001-12-slides - Evaluation and Management of the...

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Evaluation and Management of the Patient with a Neck Mass Michael Underbrink, MD Byron J. Bailey, MD December 12, 2001
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Introduction Common clinical finding All age groups Very complex differential diagnosis Systematic approach essential
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Differential Diagnosis
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Anatomical Considerations Prominent landmarks Triangles of the neck Carotid bulb Lymphatic levels
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Anatomical Considerations Prominent landmarks Triangles of the neck Carotid bulb Lymphatic levels
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Anatomical Considerations Prominent landmarks Triangles of the neck Carotid bulb Lymphatic levels
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Anatomical Considerations Prominent landmarks Triangles of the neck Carotid bulb Lymphatic levels
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General Considerations Patient age Pediatric (0 – 15 years): 90% benign Young adult (16 – 40 years): similar to pediatric Late adult (>40 years): “rule of 80s” Location Congenital masses: consistent in location Metastatic masses: key to primary lesion
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Metastasis Location according to Various Primary Lesions
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Diagnostic Steps History Developmental time course Associated symptoms (dysphagia, otalgia, voice) Personal habits (tobacco, alcohol) Previous irradiation or surgery Physical Examination Emphasis on location, mobility and consistency
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Empirical Antibiotics Inflammatory mass suspected Two week trial of antibiotics Follow-up for further investigation
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Diagnostic Tests Fine needle aspiration biopsy (FNAB) Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasonography Radionucleotide scanning
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Fine Needle Aspiration Biopsy Standard of diagnosis Indications Any neck mass that is not an obvious abscess Persistence after a 2 week course of antibiotics Small gauge needle Reduces bleeding Seeding of tumor – not a concern No contraindications (vascular ?)
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Fine Needle Aspiration Biopsy Proper collection required Minimum of 4 separate passes Skilled cytopathologist essential On-site review best
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Fine Needle Aspiration Biopsy
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Computed Tomography Distinguish cystic from solid Extent of lesion Vascularity (with contrast) Detection of unknown primary (metastatic) Pathologic node (lucent, >1.5cm, loss of shape) Avoid contrast in thyroid lesions
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Computed Tomography
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Magnetic Resonance Imaging Similar information as CT Better for upper neck and skull base Vascular delineation with infusion
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Magnetic Resonance Imaging
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Ultrasonography Less important now with FNAB Solid versus cystic masses Congenital cysts from solid nodes/tumors Noninvasive (pediatric)
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Ultrasonography YROID ASS
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This note was uploaded on 01/02/2012 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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NeckMass2-2001-12-slides - Evaluation and Management of the...

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