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Clinical Examination of the Neck
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The patient should ideally be exposed from the clavicles. Observe for lumps, skin changes and scars. Ask the patient to point to any lump if one is not obvious. Patients with midline lumps should be observed whilst drinking a sip of fluid and protruding the tongue. The thyroid gland is enveloped in pre-tracheal fascia along with the trachea. It will rise with laryngeal elevation during swallowing. Ask the patient to hold the fluid in the mouth before swallowing, giving the examiner time to concentrate on any movement. A thyroglossal cyst will elevate with tongue protrusion, being attached via the thyroglossal duct remnant to the foramen caecum of the tongue. Ask the patient to open their mouth, observe the lump and then ask them to protrude the tongue. Pemberton’s sign is elicited by asking the patient to sit and raise the arms.1 Venous congestion with facial plethora or cyanosis may indicate thoracic outlet obstruction for which a retrosternal goitre is a cause. Examination of the oral cavity to assess the parotid and submandibular ducts should accompany a thorough neck examination.
Major vessel invasion by thyroid cancer: a comprehensive review
Published in Expert Review of Anticancer Therapy, 2019
Michael S. Xu, Jennifer Li, Sam M. Wiseman
A small number of patients may also present with signs and symptoms of superior vena cava syndrome (SVCS). SVCS may occur due to either external compression caused by a retrosternal cancer and/or a metastatic lymph node mass, or due to direct intravascular extension of a tumor thrombus into the SVC [4]. In addition to the classic triad of venous dilation/distension, facial edema, and dyspnea, patients diagnosed with SVCS may also present with a Pemberton’s sign (evidenced by facial plethora or cyanosis upon simultaneous elevation of both arms), upper extremity edema, and dilated chest wall collateral veins [49–53]. In the most extreme presentation, sudden death may occur due to massive pulmonary tumor embolism or right atrium obstruction [51–53]. In the literature, there have been 31 reported cases of thyroid cancer invading the SVC, and SVCS was diagnosed in 20 (65%) of these cases. One epidemiological study reported that the clinical incidence of SVC obstruction by thyroid cancer was 0.8%, with the predominant cancer type being either PDTC or ATC [54]. In several of these reported cases, the presentation of distended neck veins was the only clinically identifiable evidence of an underlying thyroid malignancy. Nonetheless, the absence of clinical evidence of SVCS does not preclude the possibility of cancer involving the SVC, given that the 11 remaining cases with SVC involvement were asymptomatic until identified by subsequent imaging [50,55–61].