Neck (Haematological)

 

Thank you for asking me to examine Harry who presented with neck discomfort.

 

The salient findings on examination were a lymphadenopathy.

 

In further detail...

 

On general inspection, Harry appeared comfortable and non-agitated. He was dressed appropriately.

 

On inspection of the neck, there was an no anterior enlargement, which moved upwards with swallowing but did not move on tongue protrusion, consistent with the thyroid gland.

 

There was / was not dullness to percussion over the manubrium.

 

There was / was not a thyroid bruit (Graves).

 

There was submental, submandibular, superficial or posterior cervical, parotid, pre- and posterior auricular, occipital or supraclavicular lymphadenopathy. Carotid arteries were palpable, making malignant infiltration unlikely.

 

There was no evidence of mass effect with a negative Pemberton’s.

 

There was no tonsillar enlargement.

 

On further examination:

1. Feel for axillary, inguinal and hepatosplenomegaly

2. Look for other sites of disease:

   1. The gums were normal, and the tonsils were not enlarged.

   2. There was / was not bony tenderness.

3. Look for cytopenias:

   1. Look for There were / were not petechiae and ecchymoses on the arms and legs.

   2. Conjunctival pallor

4. Other complications:

   1. Scratch marks were / were not evident (myeloproliferative disease).

   2. There was / was not scleral icterus, conjunctival pallor or plethora (polcythaemia).

   3. There was / was not a Hickman’s scar.

 

In summary, my findings are of generalized lymphadenopathy without evidence of cytopenias.

 

Differentials for this include:

• Lymphoproliferative neoplasm - CLL, small lymphocytic lymphoma

• Lymphoma

• Malignant metastases - usually asymmetrical, firm

• Infective

• CTD - RA, SLE

• Infiltrative