Chapter 12: The Neck

What is the first branch of the external carotid artery?

superior thyroid artery

What is the most abundant hormone released by the thyroid?

thyroxine

A normal lymph node will not measure greater than:

10mm

result from infections and malignancy

abnormal lymph nodes

what are the sonographic findings of a branchial cleft cyst?

anechoic mass with posterior enhancement

what are the sonographic findings of a thyroglossal duct cyst?

anechoic, well defined, and unilocular cyst with posterior enhancement

an enlarged, hyperplastic thyroid gland

goiter

muscles posterior to each lobe

longus colli muscles

causes of a goiter

many causes, including iodine deficiency, Graves disease, and thyroiditis

most common cause of enlargement of parathyroid gland

parathyroid adenoma

What are the sonographic findings of an abnormal lymph node?

rounded shape, calcifications, enlargement

what is the sonographic appearance of parathyroid glands?

similar to thyroid tissue

as the disease progresses patients with Hashimoto's may present with?

slight weight gain, depression, increased cold sensitivity, and elevated blood cholesterol levels

A thyroid isthmus that measures greater than ___________ is indicative of thyroid enlargement.

10 mm

What is the normal measurement for the isthmus?

2-6 mm in AP diameter

Normally, how many parathyroid glands are found within the adult neck?

4

What are normal measurements for the thyroid?

4-6 cm L, 2-3 cm W, 1-2 cm thick

A 30-year-old patient presents to the sonography department for a thyroid sonogram with a history of weight loss, hair loss, and hyperthyroidism. You note that the patient has bulging eyes. What is the most likely diagnosis?

Graves disease

What is the most common cause of hyperthyroidism?

Graves disease

Which abnormality is associated with the sonographic findings of a thyroid inferno?

Graves disease

may be referred to as diffuse toxic goiter

Graves disease

most common cause of hyperthyroidism

Graves disease

thyroid may appear diffusely heterogeneous or hypoechoic, hypervascularity may be noted with color Doppler (termed thyroid inferno)

Graves disease

What is the most common cause of hypothyroidism?

Hashimoto thyroiditis

an autoimmune disease that is the most common cause of hypothyroidism in the United States

Hashimoto thyroiditis

patients are asymptomatic in early stages of the disease

Hashimoto thyroiditis

What are indications for a thyroid sonogram?

a palpable mass, abnormal lab findings, f/u exam from nuclear medicine and other diagnostic exam studies

most common masses identified within the thyroid gland with sonography

benign thyroid nodules

A cystic mass noted at the mandibular angle is most likely a:

branchial cleft cyst

congenital neck cysts located near the angle of the mandible

branchial cleft cysts

clinical findings in individuals suffering from hyperthyroidism include

bulging eyes, heat intolerance, nervousness, weight loss and hair loss

Parathyroid glands control the release and absorption of which nutrient?

calcium

enlargement of cervical lymph nodes

cervical lymphadenopathy

what can Hashimoto thyroiditis also be referred to as?

chronic autoimmune lymphcytic thyroiditis

What are the two prominent vascular structures seen lateral to the thyroid gland?

common carotid artery and internal jugular vein

what lab values are elevated with parathyroid adenoma?

elevated serum calcium and PTH (parathyroid hormone)

what are the sonographic findings of abnormal lymph nodes?

enlargement of the node > 1 cm, rounded shape, loss of the echogenic hilum, calcifications

What structure may be confused for a thyroid or parathyroid mass because of its relationship to the trachea and the posterior aspect of the left thyroid gland?

esophagus

most often seen on the left side posterior to the trachea and thyroid

esophagus

what are characteristics of benign thyroid nodules?

extensive cystic components, cysts <5mm, hyperechoic mass, "eggshell" calcifications, "hot" nodule (NM)

most common benign thyroid neoplasm

follicular adenomas

What can benign thyroid nodules be considered?

follicular adenomas or hyperplastic nodules

What transducer is used for a thyroid sonogram?

high-frequency linear

referred to as adenomatous nodules, are almost always multiple and have varying sonographic appearances

hyperplastic nodules

A surplus of thyroid hormones is called?

hyperthyroidism

condition that results from the overproduction of thyroid hormones

hyperthyroidism

What describes the normal appearance of a cervical lymph node?

hypoechoic, oblong structure with a distinct echogenic hilum

condition that results from the underproduction of thyroid hormones

hypothroidism

A reduction of thyroid hormones is called?

hypothyroidism

What are the sonographic findings of malignant thyroid nodules?

internal calcifications, cervical node involvement, solitary mass

Which vascular structure is located closest to the thryoid lobes?

internal carotid artery

The thyroid gland utilitzes what to produces its hormones?

iron

a bridge of tissue crosses over the midline of the neck anterior to the trachea, providing a link between the two lobes

isthmus

The thyroid consists of what lobes?

left and right

Which muscles are located posterior to each thyroid lobe?

longus colli

the presence of _________________ increases the likelihood of a malignancy

microcalcifications

the enlarged thyroid gland that contains multiple nodules with cystic and solid components may be referred to as

multinodular goiter or adenomatous goiter

What is the most common form of thyroid cancer?

papillary

appears as a solid mass that will be hypoechoic to the adjacent thyroid gland

parathyroid adenoma

serve as calcium regulators for the body

parathyroid glands

The superior extension of the thyroid isthmus is referred to as the:

pyramidal lobe

a normal variant that is a superior extension of the isthmus

pyramidal lobe

Which muscles are located lateral to each thyroid lobe?

sternocleidomastoid

muscles anterior to each lobe

strap muscles (sternohyoid, sternothyroid, and omohyoid)

Benign congenital cysts located superior to the thyroid gland near the hyoid bone are referred to as?

thyroglossal duct cyst

benign congenital cysts located within the midline of the neck superior to the thyroid gland and near the hyoid bone

thyroglossal duct cysts

an isthmus that measures greater than 10mm is indicative of

thyroid enlargement - goiter

What is the hormone that is the most abundantly produced by the thyroid?

thyroxine

What hormones does the thyroid release?

thyroxine (T4), triiodothronine (T3), and calcitonin

In the presence of Hashimoto thyroiditis, the thyroid produces:

too few thyroid hormones

symptoms of thyroglossal duct cysts

typically asymptomatic may become painful when inflamed

How many parathyroid glands are there?

typically two pairs although some have a fifth

The fluid produced by the thyroid gland that contains thyroid hormones is referred to as:

colloid

How does Hashimoto's appear sonographically?

diffusely heterogeneous, mildly enlarged, and increased vascularity within the gland

What type of gland is the thyroid gland?

endocrine

most common form of thyroid cancer

papillary carcinoma

Hypercalcemia is associated with?

parathyroid adenoma

what is the normal measurement of parathyroid glands?

5.0 x 3.0 x 1.0 mm

What gland releases TSH?

pituitary

muscles lateral to each lobe

sternocleidomastoid muscles

Which muscles are located anterior to the thyroid gland?

strap muscles