Edema in the neck
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Related concepts: tumors in the neck
The appearance of a three-dimensional process in the neck regionAdult or child usually causes serious fears in the patient, parents and the attending physician. In this case, patients or members of their family almost always think of a malignant process, but in fact it is only part of a wide range of pathologies that the doctor must differentiate. In order to assess all possible variants of the diagnosis, the examination should be carried out consistently and systematically. It should be considered as normal anatomical variants, as well as infectious diseases, congenital anomalies, benign and malignant tumors. Differential diagnosis of volumetric formations in the neck is very important, as it significantly influences the choice of the most effective method of treatment.
Diagnostic and therapeutic tactics in patients withvolume formations in the neck region depends on the age of the patient, the localization of education and the history of the disease. Wrong choice of tactics can lead to a delay in the diagnosis, unnecessary laboratory tests, unnecessary surgery, iatrogenic complications and even death of the patient, depending on the etiology of the pathological process.
Although a biopsy is certainly relativelysimple surgical operation, it is far from always necessary, and sometimes it is contraindicated. Even if there are indications for a biopsy, it is important to know how to make incisions so as not to complicate the subsequent treatment, and also what research to subject to the biopsy tissue. This is possible only after a complete differential diagnosis of suspicious education.
Biopsies are not performed according to the indications orprematurely can lead to the formation of disfiguring scars or significantly complicate the accurate execution of a surgical operation, if needed later. In addition, in this case, a delay in proper treatment is possible, and, worst of all, the patient may have a false sense of security when the patient believes that the tumor has already been removed and the illness is healed. For example, in the case of metastatic squamous cell carcinoma in adults, premature biopsy without pathogenetic treatment significantly increases the likelihood of local recurrence, wound infection and the formation of distant metastases.
Because differential diagnostics of bulkprocesses in the neck in children and adults is significantly different, their diagnostic tactics are also different. In children, congenital anomalies and inflammatory diseases occur much more often than tumors, about 90% of volume formations in the head and neck region are congenital, caused by infection or are benign tumors, and only 10% are malignant. About 27% of malignant tumors in children are observed in the region of the head and neck. Except for the contents of the orbit and brain, cervical lymph nodes more often than other formations are involved in the malignant process. In children, hyperplasia of the cervical lymph nodes causes not only infections of the upper respiratory tract, but also a number of other infectious processes (Table).
Differential diagnosis of volumetric formations in the neck region in children
Cervical lymphadenitis (bacterial, viral)
Among benign voluminous formations inneck area in children most often occur cervical lymphadenopathy, congenital cysts, lymphangiomas or hemangiomas. Approximately 80% of lymphangiomas and hemangiomas are present in the child at birth or appear in the first months of life.
Although most of the tumors in the neck in childrenhave a benign character, the doctor should always remember the possibility of a malignant process. Differential diagnosis should include all 7 types of malignant tumors, which account for 80% of malignant processes observed in children. Most often, children have tumors of lymphoid tissue, which (including Hodgkin's disease and other lymphomas) constitute 55 to 60% of all malignant tumors in children manifested in the region of the head and neck. Volumetric education in the neck in a child with equal probability may be lymphosarcoma and lymphogranulomatosis, although in general in children lymphosarcoma is found in 2 times more often than Hodgkin's disease. About 40% of children with lymphosarcoma and 80% of children with Hodgkin's disease have voluminous formations in the neck. The next primary solitary tumor of the head and neck in children is rhabdomyosarcoma. Although its source is often the nasopharynx and ear area, it can manifest itself in the form of volumetric education on the neck. Other types of tumors that occur in children (in decreasing order of probability): fibrosarcoma, thyroid malignant tumors, neuroblastoma, epidermoid cancer. A single node in the thyroid gland of a child no older than 10 years in more than 70% of cases is malignant. Early diagnosis of such malignant tumors in children is absolutely crucial, because at an early start of therapy, survival rates improve significantly.
Children have only one of ten voluminousof the formations in the neck region turns out to be malignant, but in adults older than 40 years approximately 80% of the voluminous formations on the neck are malignant, as a rule, they are metastases to the cervical lymph nodes. Approximately aU of them come from a primary tumor located above the clavicle level. The asymptomatic increase in one or more cervical lymph nodes in an adult is almost always malignant and is usually caused by metastases of the primary tumor of the oral cavity or pharynx. Benign inflammatory node hyperplasia is highly unlikely. More than 90% of metastases in the cervical lymph nodes have an ectodermal origin (squamous cell carcinoma).
It is estimated that in adults, if availablemetastatic cancer in the neck, the primary focus with a correct examination can be found in 85-90% of patients. When enlarging the cervical lymph nodes in an adult, it is always necessary to search for a primary cancer site. Any painless formation on the neck with a diameter of more than 2 cm can serve as an indication for further examination and careful observation of the patient.
It is interesting that the period from the appearance of the first symptomsbefore calling a doctor is an average of 3 months. Moreover, the average period from going to the doctor before the beginning of the corresponding therapy is also 3 months due to examination and consultation of the patient from the relevant specialist. This delay in diagnosis and treatment is very common, but in principle it can be avoided.
Volumetric education on the neck can be a symptomdiseases that threaten life. In these cases, as with all malignant oligochoons, early diagnosis often improves the results of treatment, reduces mortality. Therefore, the diagnostic search should be aimed primarily at identifying the most serious, life-threatening diseases (cancer) and at the same time not delaying the initiation of treatment. The range of diagnostic methods should be wide enough to be able to identify other serious diseases without endangering the patient's life.