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THYROID PATHOLOGY Congenital Abnormalities Agenesis of the whole gland or one lobe of the thyroid. Congenital absence of the entire thyroid. Note the empty fossae where the right and left lobes would normally lie. The carotid artery and jugular vein of both sides are seen in the color doppler images. http://www.ultrasound-images.com/thyroid.htm Ectopic thyroid tissue Thyroglossal duct cyst Inflammatory and Immune Conditions Thyroiditis: causes swelling and tenderness of the thyroid which can be caused by inflammation or autoimmune diseases. Thyroid gland may appear enlarged and hypoechoic. +/- increased vascularity Sub Acute Thryoiditis: Diffuse enlargement of the thyroid gland which is often painful. Hashimoto’s disease: also known as chronic autoimmune lymphatic thyroiditis inflammatory disease of the thyroid usually characterised by diffuse enlargement often associated with Hypothyrodism. Hashimoto’s Thyroid with hypervascularity of Thyroiditis http://www.sonographers.ca/data/storage/attachments/32daa114b821a66c72608430a73b5198.jpg Graves’ disease: common cause of Hyperthyroidism. Diffuse thyroid gland which may have an otherwise normal ultrasound appearance. o the thyroid gland is often enlarged and can be hyperechoic o the is a realtive absence of nodularity in uncomplicated cases. o hyper vascular and may demonstrate a "thyroid inferno" pattern on colour Doppler http://images.radiopaedia.org/images/546363/f0c69534100632d7c0315b93c2a1ba_thumb.jpg Cysts Are thought to represent cystic degeneration of a follicular adenoma. Usually benign, well defined with increased posterior acoustic enhancement. http://www.alexfok.com/graphics/US%20Thyroid%20Cyst.jpg Goitre Is enlargement of the whole gland, due to hyperplasia. The degenerative changes within the goiter means they exhibit a range of ultrasound appearances, anechoic lesions, debris filled lesions, bright echogenic lesions, iso,hypo and hyperechoic lesions. Multiple cystic lesions in both lobes of the thyroid. There is also evidence of few nodular, solid masses within the lobes. Color doppler imaging reveals multiple vessels around the lesions. Suggestive of a multinodular goitre. http://www.ultrasound-images.com/admin/uploads/Thyroid-cysts-1b.jpg Benign Adenoma or Colloid Lesions Areas with no ‘cold ‘uptake on a radioisope scan, within the thyroid gland. Benign solid tumor of the thyroid gland common thyroid nodule solid lesions which may contain cystic areas that may undergo necrosis or haemorrhage Benign solid tumor of the parathyroid gland (which secretes parathyroid hormone resulting in high serum calcium levels) A rim like calcification may also be seen with adenomas May have a halo of hyperechoic tissue and localized calcification. http://radiology.rsna.org/content/247/3/762/F4.medium.gif Thyroid Carcinoma Malignancy occurs in approximately 1% of thyroid nodules. Papillary and/or mixed papillary/follicular carcinomas are by far the most common malignancy. The incidence is dramatically increased in post head/neck radiotherapy patients. o Papillary Carcinoma 78% o Follicular Lesion Carcinoma 17% o Medullary Carcinoma 4% o Anaplastic Carcinoma 1% o Thyroid lymphoma - rare o Thyroid metastases - rare http://www.ultrasoundpaedia.com/normal-thyroid/ o Papillary Thyroid Carcinoma 1. Solid hypoechoic mass 2. Microcalicifications 3. Increased vascularity 4. Cervical lymph node metastasis Left lobe- long section Left lobe nodule-long with colour Doppler. Transverse section of thyroid Microcalcifications http://www.ultrasound-images.com/thyroid.htm o Follicular Carcinoma Irregular margins Thick irregular halo Tortuous and irregular blood vessels Large, solid, echogenic, homogenous oval nodule with a hypoechoic halo around the lesion, in the right lobe of thyroid. http://www.ultrasound-images.com/admin/uploads/follicular-adenoma-1a.jpg The lesion is solitary, shows no cystic areas and has a rim of vessels entering it's central area. These ultrasound images are diagnostic of a benign follicular adenoma of the thyroid. http://www.ultrasound-images.com/admin/uploads/follicular-adenoma-1a.jpg o Medullary Carcinoma May involve all gland or just small portion Bright echogenic foci within solid mass Cervical lymph node metastasis Medullary thyroid carcinoma on ultrasound with typical small calcifications (arrows) http://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/Medulaeres_SDCa_mit_Verkalkungen.jpg/220px-Medulaeres_SD-Ca_mit_Verkalkungen.jpg o Anaplastic carcinoma Hypoechoic May surround or invade blood vessels May invade neck muscles. Usually occurs over the age of 50 Ill defined lesion with minimal cystic degeneration or echogenic foci. Anaplastic thyroid carcinoma in an 84-year-old woman. Transverse sonogram of the left lobe of the thyroid shows an advanced tumor with infiltrative posterior margins (arrows) and invasion of prevertebral muscle. http://radiographics.rsna.org/content/27/3/847/F7.small.gif