An infant is brought to the clinic by the parents with the history of a swelling in the neck since birth. On examination, the swelling is found to be soft, partially compressible and brilliantly trans-illuminant. The most likely diagnosis is
cystic hygroma
The correct answer is cystic hygroma, a macrocystic lymphatic malformation caused by failure of the jugular lymph sacs to connect with the venous system. About 65-75 percent arise in the posterior triangle of the neck and roughly half to two-thirds are evident at birth. Because the loculi contain clear lymph, the swelling is soft, fluctuant, partially compressible and brilliantly trans-illuminant, the key bedside sign. It may swell on crying and large lesions threaten the airway; associations include Turner and Noonan syndromes. Treatment is sclerotherapy with OK-432 (picibanil) or bleomycin, or excision.
A sternomastoid tumour is a firm, fusiform, non-transilluminant swelling in the sternocleidomastoid appearing at 2-3 weeks with torticollis. A branchial cyst lies at the anterior border of the upper sternocleidomastoid, contains turbid cholesterol-rich fluid so does not transilluminate, and presents in young adults. A thyroglossal cyst is midline and moves on deglutition and tongue protrusion.
Key point: A brilliantly trans-illuminant, compressible posterior triangle swelling present since birth is a cystic hygroma until proved otherwise.
Important Questions from Neck & Breast Surgery
- A midline neck swelling just below the hyoid bone and managed by Sistrunk's operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is
- A 60-year-old lady presents with a recent onset increase in a long standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?
- A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from
- Which of the following are included in triple assessment in case of breast?
1. Clinical assessment
2. Radiological assessment
3. Histopathological assessment
4. Sentinel lymph node biopsy
Select the correct answer using the code given below. - A gentleman of 60 years presented with a brawny swelling of the sub- mandibular region with inflammatory oedema of mouth and putrid halitosis. Most likely he is suffering from
