Case Presentation

A 40 year old male presenting with anterior

neck swelling for 3 months

Presented by Dr Sovit
Moderated by Dr Sourabha

Patient details
Name: Raj Kumar
Age/Sex:
40 yr/male
Address:
Barwala, Haryana
CR No.: 201303752555

Chief Complaint

Swelling in front of lower neck for 3 months

Case Summary
Patient Raj Kumar 40yr/Male ,from Barwala, Haryana
presented to ENT OPD with complaint of swelling in Lt
anterior neck for 3 months which was insidious in onset ,
gradually progressive. Not a/w h/o difficulty in deglutition
or noisy breathing or dyspnea on exertion, change in
voice, any symptoms of hypo or hyper thyroidism and
with no suggestive past or family history, with no
previous history of radiation, chronic drug intake or food
taboo or food likes.

O/E
76 cm firm, mobile, non tender, non pulsatile, well defined
globular swelling on Lt lower side of neck extending from
Sup Inf Lat-

Upper border of thyroid cartilage,

Just above the suprasternal notch and Lt clavicle
Between ant border of Rt SCM and post border of Lt SCM.

Moves up on deglutition, doesnt move on protrusion of

tongue.
No other swellings palpated in the neck or anywhere else in
the body.
Indirect laryngoscopy- WNL.
Ear, Nose and Ocular examinations are WNL.

Differential Diagnosis

From history and clinical examination the swelling

appears to be arising from thyroid gland. So, for this
patient, my differential diagnoses are limited to thyroid
swellings primarily.

Thyroid Swellings can be of types

GOITRE

GOITRE
INFLAMMATORY

INFLAMMATORY

NEOPLASTIC

SIMPLE

TOXIC

INFECTIVE

BENIGN

COLLOID

DIFFUSE
(GRAVES)

AUTOIMMUNE

MALIGNANT

MULTINODULAR MULTINODULA
R
TOXIC
ADENOMA

GRANULOMATOUS
REIDELS
THYROIDITIS

Colloid Goitre
IN FAVOUR OF

AGAINST

Well defined smooth solitary swelling

with absence of nodularity

Sex

Absence of toxic features

Short duration

Mobile

Consistency

Non tender

Benign Thyroid Swelling

IN FAVOUR OF

AGAINST

No history of difficulty in swallowing/breathing/HOV

Sex

Age
Smooth single globular swelling with well defined margins
Mobile freely in all directions
No Lymphadenopathy
Consistency

Short Duration

Malignant thyroid swelling

IN FAVOUR OF

AGAINST

Sex

Age

Consistency

Smooth swelling with well defined

margins

Short duration

No lymphadenopathy
Free mobility
Absence of infiltrative symptoms

Other possibilities
Other thyroid swellings that move up with
deglutition can be
Thyroglossal cyst
Subhyoid bursitis
Lymph node attached to crico-tracheal
framework

Thyroglossal cyst
IN FAVOUR OF

AGAINST

Moves with deglutition

Age
Firm consistency
Located in lower Neck
Does not move on protusion of tongue

Subhyoid bursitis
IN FAVOUR OF

AGAINST

Moves with deglutition

Location
Size
Absence of tenderness

Lymph node attached to crico-tracheal

framework
IN FAVOUR OF

AGAINST

Moves with
deglutition

consistency
mobility
Well defined margins
No suggestive history of addictions or no e/o primary or other lymph
node mass