title: Rheumatoid nodule of the thyrohyoid membrane: a case report.
abstract: BACKGROUND
  Rheumatoid nodules are common extra-articular findings occurring in 20% of rheumatoid arthritis patients. They develop most commonly subcutaneously in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and in other connective tissues elsewhere in the body
  
  
  METHODS
  We present the case of a 62-year-old male who presented with a midline neck mass. Clinically it moved on swallowing and tongue protrusion-suggesting attachment to the thyrohyoid membrane. Ultrasound examination revealed a cystic lesion in the absence of cervical lymphadenopathy in a non-smoker. The neck was explored and histological examination of the excised lesion which was attached to the thyrohyoid membrane revealed a rheumatoid nodule.
  
  
  CONCLUSIONS
  A rheumatoid nodule of the thyrohyoid membrane is very rare. The triple diagnostic scheme of clinical examination supplemented with ultrasound and guided fine needle aspiration for neck lumps remains valid in most cases. If excision is indicated we feel it should be performed in such a manner that the scar tract could easily be encompassed in a neck dissection excision should definitive histological examination be adverse. We suggest that when dealing with patients with established rheumatoid arthritis one should consider a rheumatoid nodule as a differential diagnosis for any swelling on the patient whether it be subcutaneous or deep.
authors.affiliation: The Ear Institute, University College London, UK. mrtupile@yahoo.com.
authors.forename: Tahwinder
authors.initials: T
authors.lastname: Upile
authors.forename: Waseem
authors.initials: W
authors.lastname: Jerjes
authors.forename: Fabian
authors.initials: F
authors.lastname: Sipaul
authors.forename: Sandeep
authors.initials: S
authors.lastname: Singh
authors.forename: Colin
authors.initials: C
authors.lastname: Hopper
authors.forename: Anthony
authors.initials: A
authors.lastname: Wright
authors.forename: Ann
authors.initials: A
authors.lastname: Sandison