Download AACE/ACE Principles of Endocrine Neck Sonography Course

AACE/ACE Principles of Endocrine Neck
Sonography Course™
May 2016
Content contributed by: H. Jack Baskin,
Daniel Duick, Diana Dean, Robert A. Levine,
Mark Lupo, Dev Abraham, John Abele, and
Susan Mandel, Alex Tessnow
Thyroid Ultrasonography
Defining the Anatomy of the Neck
AACE/ACE Principles of
Endocrine Neck Sonography
Course™
Thyroid
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Term derived from Greek
word, Thureos, an ancient
oblong shield
Neck Anatomy
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Derived from endodermal
tissue at base of tongue
1st gland to develop – day
24
Embryonal remnants form
Thyroglossal duct; pyramidal
lobe; lingual thyroid
Fuse with C-cells (neural
crest origin)
C-cells scattered through
posterior/superior lobes
Neck Anatomy

Wharton 1656: “purpose is
to… beautify the
neck…particularly in
females to whom for this
reason a larger gland..”
Deposition Van der Weyden c. 1435
Thyroid Anatomy
• Largest endocrine
gland (~20 g)
• Fills the tracheoesophageal space
• Overlies RLN
bilaterally
• Parathyroids lie at
each pole (usually!)
The Thyroid Gland
• Initial descent occurs anterior to
pharyngeal gut
• Connected to the base of tongue via
thyroglossal duct. Obliterates entirely in
7-10th week of gestation
• Remnants:
Thyroglossal duct cyst
Lingual thyroid (base of tongue)
Thyroid Ultrasonography
• “Real time” information to the clinician
• Very sensitive tool. Can detect nodules
only 2-3 mm in size. Lacks specificity
Thyroid Ultrasonography
Advantages
Painless
 No radiation or contrast material
 Less expensive than CT / MRI
 May use in pregnancy
 Most sensitive modality for thyroid
nodules
 Best imaging for guided FNA.
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Isthmus
Sternocleidomastoid muscle
Sternohyoid muscle
trachea
Internal jugular vein
Sternothyroid muscle
Omohyoid muscle
esophagus
Carotid artery
Parathyroid gland
Longus colli muscle
Normal Thyroid – Composite View
Strap
IJ
CA
R Lobe
LCM
See addendum in syllabus.
SCM
Trach
L Lobe
Esoph
Transverse View – High
Neck
Transverse View – Mid
Neck
See addendum in syllabus.
Transverse View – Low Neck
STM
SHM SCM
I
RL
CA
T
LL
IJV
CA
Normal Thyroid – R Transverse
High
Mid
Low
Normal Thyroid – L Transverse
High
Mid
Low
Normal Thyroid – L Sagital
Lateral
Mid
Medial
Thyroid Echogenicity
Normal thyroid: High intensity
homogeneous echo pattern with little
identifiable internal architecture
 Muscles located anteriorly and
anterolaterally are less echogenic
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Thyroid Echogenicity
Normal thyroid
(longitudinal view)
Note bright homogeneous
echotexture
Hashimoto’s thyroiditis
Note heterogeneous
(hypoechoic) echotexture
Appearance of
the Esophagus
(post thyroidectomy)
Left Sagital View – Note tangential image of esophagus
Diffuse Goiter
Normal isthmus <0.5cm
Diffuse Goiter
(Hashimoto’s)
Measurement of Thyroid
Width and Depth
Measurement of Thyroid
Length (sagital / longitudinal)
Volume = p/6(WxDxL)
ISTHMUS
Pyramidal Lobe
Surgical Levels of the Neck
See Addendum in back of
Syllabus.
Som et al, AJR 174:837 2003
Normal Lymph Nodes
Typical location of Parathyroid
Glands
Summary
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Ultrasound is an anatomic imaging tool, whose
utility requires a thorough understanding of neck
anatomy
Ultrasound does not generate pre-defined image
planes, and is therefore highly operator dependent
Ultrasound is a functional imaging tool, through
inquisition of blood flow patterns by Doppler
Ultrasound is a real-time imaging tool, which
permits accurate localization of biopsy needles