Clinical Handbook of Ear, Nose and Throat Disorders (Clinical Handbook Series) by William R. Wilson;J.B. Nadol Jr;Gregory W. Randolph

Author:William R. Wilson;J.B. Nadol Jr;Gregory W. Randolph
Language: eng
Format: epub
Published: 2009-06-19T12:00:00+00:00

Once the initial evaluation is complete, a working differential diagnosis is constructed (see Table 11.2 for a complete differential diagnosis of 'a neck mass).

Lymphadenopathy

Lymphadenopathy may consist of either inflammatory or neoplastic disorders. In both, knowledge of the afferent supply of the involved lymph node is critical for further evaluation. In the presence of acute infectious disease such as pharyngitis, tonsillitis, dental or skin infection, or upper respiratory tract infection, no further diagnostic maneuvers may be necessary to formulate a diagnosis for the cause of the lymph node enlargement. Acute inflammatory nodes are usually tender, mobile and doughy.

A frequent diagnostic problem involves the identification of a probable lymph node and the inability to determine whether the node represents a chronic infectious or inflammatory disorder such as toxoplasmosis or sarcoidosis, or a primary or metastatic neoplastic process. All nodes should be considered neoplastic until proven otherwise, and several steps should be undertaken before an open biopsy of the neck is considered. Although it would seem that biopsy of the node would save time in the diagnostic work-up, there is evidence that premature open biopsy of a neoplastic node later identified as having metastasized from a head and neck primary tumor may result in a poorer prognosis than if the primary node and metastasis had been treated in an orderly fashion. Proper evaluation of a node requires a careful history of associated symptoms, including the identification of dysphagia, hemoptysis, hematemesis, hoarseness or a sensation of a mass in the mouth or throat. A history of drinking and smoking should be obtained. A thorough head and neck examination, including mirror or fiberoptic examination of the larynx, is also performed.

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