by Alberto J. Muniagurria and Eduardo Baravalle
Neck skin lesions are indistinguishable from dermal lesions described in the section "Abnormal findings on skin examination." It is also possible to observe scars, of which the most frequent is the scar from thyroid surgery, which is seen as a cut parallel to the folds of the neck.
In the neck region, ganglion masses or enlargements of the cervical organs (thyroid, submaxillary glands, cervical portion of the parotid, carotid aneurysms, esophageal diverticula, thyroglossal duct cysts, tumors or tracheal deviations) can be palpated.
In the presence of lymph node enlargement, the location, shape, size, consistency, sensitivity, adherence to superficial or deep planes, and fistulization to superficial planes should be defined. Pain is linked to inflammatory processes and hardness and adherence to neighboring tissues is related to tumor processes.
An enlarged thyroid gland is called a goiter. It can be diffuse (multinodular smooth) or have a solitary nodule. Among the smooth diffuse enlargements, endemic goiter and Graves-Basedow disease are worth mentioning, while among the multinodular diffuse goiters the most common is that of metabolic origin. Solitary nodules can be cystic or solid, malignant or benign, and dependent or not on thyrotropin. The presence of a murmur at the level of the thyroid gland should make one suspect Graves-Basedow disease. Whenever a thyroid enlargement is observed, satellite lymphadenopathy will be looked for.
Carotid aneurysms, at the cervical level, are rare and are manifested by a. pulsatile mass, in the course of the carotid, which may be accompanied by the auscultation of a murmur. Esophageal diverticula, in turn, are tumors that increase in size during food intake and patients complain of halitosis.
The thyroglossal duct extends from the lingual V to the thyroid cartilage, and is normally obliterated during fetal development. Due to abnormalities in their development, these holes may be visible and cystic tumors may be found along their path.
Deviations of the trachea to the right or to the left can be caused by neck tumors or by intrathoracic pathology, which by pressure variations or by traction-retraction displace the structures (pleural effusions, massive atelectasis, thoracoplasty pneumothorax).
It is also possible to find venous engorgement in the neck and edema in the region of the shoulders and neck (edema in slavina), which are part of the mediastinal syndrome.
When palpating the neck muscles, it is possible to find spasms, which may be due to traumatic, localized inflammatory, or generalized infectious processes (tetanus, meningitis), and the contracture is often a manifestation of hysteria or due to antalgic postures.
Other times, superficial palpation can detect crackles corresponding to subcutaneous emphysema seen in some patients with pneumothorax.
The carotid pulse should be palpated and auscultated. The alterations in its frequency, rhythm, amplitude, and shape have been described in Chapter 16. To determine if a pulse is present or if there is a decrease in the pulse wave, it should be compared with that of the opposite side. The absence or deficiency of pulse or difference in blood pressure between two arms suggests an occlusion of the subclavian artery in its proximal part. In some patients, this occlusion stimulates the development of collateral circulation to the affected arm, which comes from the vertebral system. This communication can produce the picture known as subclavian steal syndrome, in which the patient, during exercise, presents manifestations of vertebral failure.
When a murmur is heard below the mandibular angle, the lesion should be looked for at the bifurcation of the carotid artery. A murmur heard at the base of the neck, at the level of the middle of the clavicle, corresponds to a stenosis of the subclavian artery, and it is also heard in the axillary hollow.