Journal

Reading

Ultrasound Features of Thyroid and

Parathyroid Lesions

PRESENTAN :
NISAUL HAFIZA
11-095

PRESEPTOR :
DR DESSY WIMELDA, SP. RAD

SMF RADIOLOGI OF RSUD SOLOK

2016
Introduction
Anamnese

Evaluation
of thyroid
lesions
Epidemiology

Nodular
Female thyroid
>> disease

Colloid
multinodullar
goiter
Parathyroid
adenoma Primary
hyperparathyroidism
tumors
Discussion

Symtoms
of the
thyroid
disease
Disease of the Thyroid gland
Mulitinodular
Thyroid adenoma
Benign thyroid masses
Thyroid adenoma
Solitary nodul or mulitinodular
USG : hiperechoic, isoechoic or hypoechoic of solid
masses

Have a smooth and thick peripheral hypoechoic

halo
Spoke-and-wheel-like appearance
Multinodular goiter

Adenomatous or colloid
multinodular goiter >>
35-50 years old >>
Females : males = 3 : 1
Initial stage : cellular hyperplasia
of thyroid acini
Nodule formation
Undergo cystic degeneration and
calcification coarse and
perinodular
USG : Nodul isoechoic >>
Abnormal : hyperechoic
Sign of Increased size : matrix more inhomogeneous
Purely anechoic areas due to serous or colloid fluid
Echogenic fluid or
moving fluid-fluid levels
correspond to
hemorraghe, bright
echogenic foci with
comet-tail artifacts due
to presence of dense
colloid material
Papillary Carcinoma

Younger age >>

Third and fourth decades >>
Spread by lymphatic to nearby cervical lymph nodes
Present with enlarged cervical lymph nodes with
normal thyroid gland
Distant metastases are rare
USG feature :
Hypoechogenicity (90%)
with minimal colloid
substances
Microcalcifications
Cervical lymph node
metastases
Follicular carcinoma

Female >>
Fifth decade >>
Two variants :
minimal invasive follicular carcinoma
widely invasive follicular carcinoma
Spread via the blood stream >>
Distant metastases to bone, lung, brain, liver >>
USG features :
Irregular tumor margins
Thick irregular halo
Tortuous or chaotic
arrangement of internal
blood vessels on color
doppler
Medullary carcinoma

Parafollicular cells or C
cells
Familial (20 %)
Component of MEN type
II syndromes
MEN syndrome ---- in 35
years old >>
Multicentric and/or
bilateral
USG features :
Similar with papillary
carcinoma
Local invasion and
metastases to cervical
nodes >>
Bright echogenic foci
(80-90%)
Can be seen in
metastatic lymph
nodes, hepatic
metastases
Anaplastic carcinoma

Old age >>

Most lethal of solid tumors
USG feature : hypoechoic,
invade blood vessels and
muscles, show areas of
necrosic and hemorraghe,
amorphous calcification
Congenital lesions of the thyroid gland

Hashimoto's
Thyroiditis
(Lymphocytic
Lingual Thyroid thyroiditis)
gland and
Thyroglossal
duct cyst:
Lingual Thyroid
gland and
Thyroglossal
duct cyst:
CT Scan : hyperdense lesion at he base of tongue

With radionuclide imaging

Thyroglossal cyst usually found in midline at the
level of hyoid bone or thyroid cartilage
USG : anechoic to hypoechoic lesion with internal
echoes due to internal hemorrhage or infection
 Hashimoto's
Thyroiditis
(Lymphocytic
thyroiditis)
Disease of Parathyroid Glands

Two types of hiperparathyroidism :

- Primary hyperparathyroidism
Adenomas (80-85 %)
Hyperplasia (15-20 %)
Carcinoma (<3 %)
Secondary hyperparathyroidism

Women : men = 3 : 1
Present with signs symptoms of hyperparathyroidism
Parathyroid adenomas

Common cause of primary hyperparathyroid

Solitary lesion
USG :
Size and shape : oval, oblong shape
Diameter :0,8-1,5 cm
Hypoechoicappearancee is due to the uniform
hypercellularity of the gland
Internal architecture : solid, rarely it may contain
calcification
Typical location : adjacent to the posterior aspect of
the mid portion of the thyroid gland, variable but
usually it lies close to caudal tip of lower pole of the
thyroid gland
Ectopic location : retrotracheal adenoma,
mediastinal adenoma, intrathyroid, carotid sheath
adenoma
Parathyroid hyperplasia

Enlargement of multiple parathyroid glands

USG : semilar to small parathyroid adenomas.
Parathyroid carcinoma

<<
Have no specific imaging features
Have lobulated countour, heterogenous internal
architecture, calcifications,, internal cystic
componen,
TERIMA KASIH