The child with a neck swelling
Kayleigh is a 13-year-old girl who has recently noticed a neck swelling. Please examine her.
Next, you look at her neck.
On examination, she has an enlarged, firm thyroid swelling.
Inspect
- Sitting
- Look at neck from all angles (goitre)
- Look for any redness (thyroiditis)
- Confirm by sipping water if swelling present (moves upwards)
- Ask to protrude tongue (thyroglossal cyst)
- Ask them to cough and speak
Palpate
Palpate thyroid from behind - describe
- Size
- Shape
- Symmetry of lateral lobes
- Smooth (thyrotoxicosis, thyroglossal cyst) or irregular (MN goitre)
- Consistency (fluctuant with thyroglossal cyst)
- Fixation (malignancy)
- Tenderness (subacute thyroiditis, acute suppurative thyroiditis)
- Any mass in suprasternal notch (retrosternal extension)
- Thrill (thyrotoxicosis, diffuse toxic goitre)
- Transillumination (thyroglossal cyst)
Also palpate:
- Carotids (absent with malignant extension)
- Lymph nodes
- Position of trachea
Percuss
Percuss the upper sternum from right to left (retrosternal extension)
Auscultate for bruits (thyrotoxicosis, diffuse toxic goitre)
Check for:
- Horner syndrome (malignancy)
- Pemberton's sign (facial plethora/raised JVP/inspiratory stridor when raise arms – thoracic inlet obstruction)
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