Pathology · patient case question
What is the MOST likely diagnosis?
Patient case: Neck swelling that worsens with meals
Patient: 41-year-old woman.
Chief complaint: A lump in my neck that swells up and hurts when I eat.
History: Three months of intermittent swelling. The swelling and pain build during meals and settle over the following hour. No fever, no weight loss.
Findings: A soft, doughy swelling in the anterior neck. Bimanual palpation of the floor of the mouth elicits tenderness along the course of the left submandibular duct. Scant saliva expressed from the duct orifice.
Show answer and explanation
Correct answer: B. Obstructive submandibular sialadenitis from a sialolith
- A. A space infection presents with fever, trismus, systemic upset and a firm indurated swelling that does not come and go.
- B. CORRECT. Swelling and pain PROVOKED BY EATING is the defining history of obstructive salivary disease. Meals stimulate flow; an obstructing stone backs saliva up and the gland swells painfully, then settles. The submandibular gland accounts for 80 to 90 percent of salivary calculi because its secretion is mucous and alkaline and Wharton's duct runs uphill.
- C. A thyroglossal duct cyst sits in the MIDLINE and characteristically moves on swallowing or tongue protrusion. It does not fluctuate with meals.
- D. A reactive node is a discrete, mobile swelling unrelated to eating.