Mrs BL, a 54 year old housewife, no known medical illness, presented to the clinic in Selayang Hospital with complaint of painless progressive enlargement of neck swelling since 5 years ago located at the center extending to the right side of the neck. It was associated with tiredness, insomnia, constipation and amenorrhea for 2 years.
INSPECTION
The swelling moved with swallowing. The swelling is in the central part of the neck extending to the right side, ovoid in shape with the measurement of approximately 5cm in height, 10cm in length and 3cm in thickness. The skin overlying the swelling is smooth with no break and had no erythema. There are no dilated veins seen. There are no visible pulsation seen.
PALPATION
On palpation, the swelling is well defined, smooth, soft and nontender. There was on nodule appreciated and it moves with swallowing. The isthmus and tracheal margin could not be appreciated. There were no palpable supraclavicular lymph node.
PERCUSSION
Percussion on the sternum was resonance.
AUSCULTATION
On auscultation, there was no carotid bruit heard.
what's ur differential diagnosis???
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