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Demo Question


A 20-year-old woman is followed up two months after her initial presentation with a painful, tender, midline neck swelling. The lump moves upwards on swallowing. She was treated with antibiotics and the infection has resolved.

Which investigation should be undertaken before any surgical treatment?

 Calcium and PTH assessment

 Flexible nasoendoscopy to assess vocal cord function

 Lateral soft-tissue x ray of the neck

 Thyroid function tests

 Ultrasound scan of the neck

Key Learning Point


Ultrasound imaging is extremely useful in differentiating midline cystic neck swellings.



The likely diagnosis is a thyroglossal cyst.

Before excising any thyroglossal cyst an ultrasound scan is needed to confirm the presence of a normal thyroid gland. Rarely, ectopic thyroid tissue can be present in the excised specimen, a remnant from the descent of thyroid in early fetal life.


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