Peds Head and Neck

A history of a traumatic breech or forceps delivery is frequent.

Fibromatosis colli

Margins are usually well defined, and a hypoechoic rim, which is thought to represent normal peripheral muscle, may be seen

Fibromatosis colli

Occasionally, bright punctate foci with acoustic shadowing, representing calcifications, can be noted.

Fibromatosis colli

On elastography, the stiffness of the affected muscle is higher than that of normal muscle 130

Fibromatosis colli

Sonography shows fusiform enlargement of the sternocleidomastoid muscle

Fibromatosis colli

The echogenicity is variable and can range from hypo- to hyperechoic relative to normal muscle.

Fibromatosis colli

Treatment is conservative, consisting of serial stretching exercises. The lesion usually resolves over 4 to 8 months

Fibromatosis colli

also referred to as a pseudotumor of infancy or sternomastoid pseudotumor, is a benign lesion resulting from contracture of the sternocleidomastoid muscle.

Fibromatosis colli

Patients present shortly after birth with torticollis and a painless, firm mass that is commonly on the right side.

Fibromatosis colli (sternomastoid pseudotumor)

It arises in glands that are otherwise normal and can present as a palpable nodule, be found incidentally on imaging examinations performed for other indications, or, less often, present with sudden enlargement and pain due to spontaneous hemorrhage.

Follicular adenoma

Most are nonfunctioning, but they may cause hyperthyroidism due to autonomous function, resulting in continuous production of thyroid hormone

Follicular adenoma

____ _____ is the most common benign thyroid gland neoplasm. Pathologically, it contains follicles that are surrounded by a fibrous capsule.

Follicular adenoma

an enlarged, round, hypoechoic lymph node with loss of a normal hilum and eccentric blood flow

Lymph node metastasis rhabdomyosarcoma

following sclerotherapy; color Doppler views. Internal contents are echogenic secondary to treatment. Flow is noted within septa and the walls of the _____ but not within the debris filled locules.

Lymphangioma

Doppler images of a newborn girl with a right neck mass show a large, avascular, septated, cystic mass

Lymphangioma - cystic hygroma

Color flow Doppler imaging shows flow in the soft tissue septations, but not in the fluid-filled locules.

Lymphangiomas

____ appear as thin-walled, multilocular, fluid-filled masses with echogenic septations.

Lymphangiomas

a soft, asymptomatic mass in the area of the salivary glands.

Lymphangiomas

congenital malformations characterized by dilated lymphatic channels

Lymphangiomas

They are endothelial-lined, dilated lymphatic spaces separated by connective tissue stroma, arising from congenital blockage of lymphatic drainage.

Lymphangiomas (cystic hygromas)

__________ are characteristically located in the posterior triangle of the neck and most frequently on the left side

Lymphangiomas (cystic hygromas)

Affected children present with painless, firm, fixed, and enlarging cervical adenopathy

Lymphoma

color Doppler views show an enlarged hypoechoic node with peripheral flow. patient shows multiple enlarged nodes with chaotically branching vessels. The normal central hilar echogenicity and vascularity are absent.

Lymphoma

_____ lymph nodes may be enlarged discretely or appear as a conglomerate soft tissue mass

Lymphomatous

The sonographic appearance can mimic that of inflammatory adenopathy, and correlation with clinical findings and/or tissue sampling is required for diagnosi

Lymphomatous lymph

They are typically hypoechoic to muscle and homogeneous. Bilateral involvement is common. Color Doppler patterns are variable and include central or hilar vascularity typical of benign nodes and peripheral or chaotically branching vessels typical of metastases

Lymphomatous lymph nodes

____ _____ ______ cervical ectopic glands are rare.

Mediastinal and lateral

____ _____ _____ has an association with multiple endocrine neoplasia

Medullary thyroid cancer

____ nodal disease in children is usually from head and neck rhabdomyosarcoma and less frequently from thyroid carcinoma and neuroblastoma.

Metastatic

Longitudinal image shows an elongated lobular structure that communicates with an upper cervical dorsal nerve root

Nerve sheath tumor.

Affected children typically present with a painless, firm, lateral neck mass. Other presented findings include airway obstruction, dysphagia, hoarseness, Horner syndrome, nd paralysis of the lower cranial nerves.

Neuroblastoma

___ is the common malignancy of the head and neck in children under 5 years of age

Neuroblastoma

right neck posteriorly demonstrates a large soft tissue mass adjacent to the cervical spine. The mass invades the spinal canal. Hyperechoic foci represent calcifications.

Neuroblastoma

At sonography, peripheral nerve sheath tumors are hypoechoic with a homogeneous matrix, posterior acoustic enhancement, and internal blood flow

Neurofibromas

Continuity with a peripheral nerve suggests the diagnosis. Sonography cannot reliably distinguish neurofibromas from ganglioneuromas or schwannomas, but the latter are rare in children.

Neurofibromas

______ are benign peripheral nerve sheath tumors composed of Schwann cells and fibroblasts.

Neurofibromas

usually affect children with neurofibromatosis (NF) type 1, although they may be sporadic.

Neurofibromas

___ ___ from papillary thyroid carcinoma may contain scattered calcifications.

Nodal metastases

Patients with acquired causes of ____ present with symptoms that include growth failure, cold intolerance, fatigue, bradycardia, dry skin, goiter, weight gain, and delayed bone maturation

hypothyroidism

____ ____ more often is caused by a solitary adenoma (80% of cases) arising within the parathyroid gland and less often by diffuse glandular hyperplasia (about 20% of cases).

Primary hyperparathyroidism

____ ____ _____ in children are usually neuroblastoma, lymphoma, or rhabdomyosarcoma

Primary malignant tumors

The sonographic findings vary from a solitary, hypoechoic mass to multiple hypoechoic and anechoic masses replacing the thyroid gland

lymphoma

Thyroid involvement by ____ is rare in children and adolescents

lymphoma

The remaining _______ include neuroblastoma, other sarcomas (fibrosarcoma, neurofibrosarcoma), and Langerhans cell histiocytosis

malignancies

The findings that are suggestive of _____ are: a solid or predominantly ____ lesion, fine punctate ______, ____ _____ and poor margination, a shape that is ____ than wide, extension beyond the thyroid margin, and nodal metastases

malignancy; solid; calcifications; irregular contours; taller

In children, 22% to 26% are ____ ____ to a 5% to 10% of incidence of cancer in adult thyroid nodules; Most thyroid nodules present as _____ ____

malignant compared; palpable masses

Color Doppler imaging shows irregular vessels in a chaotic or peripheral subcapsular distribution. Central hilar flow is characteristically absent

malignant nodes

The sonographic findings of ___ ___ are a round hypoechoic mass with a homogeneous or heterogeneous matrix, absent hilum, and irregular margins

malignant nodes

There is greater enlargement of the short-axis than the long-axis dimension.

malignant nodes

Patients usually present with a painless, enlarging lump in the salivary gland.

malignant salivary gland tumors in children

Color Doppler imaging shows moderate to marked vascularity with central, peripheral, or combined distribution

malignant tumors

The common ____ ____ are low grade mucoepidermoid and acinar cell carcinomas

malignant tumors

Lymphangiomas: Smaller lesions are well-___, while larger lesions often are infiltrative and have ___________

marginated; ill-defined borders

In the upper neck, the common carotid artery and internal jugular vein lie ____ ____ ___ to the strap muscles.

medial and posterior

The ____ ____ can intermittently herniate into the neck, presenting as a lateral or midline neck mass.

mediastinal thymus

Differentiation of the two conditions is important because adenopathy is treated ____ and abscess usually requires _________________________.

medically; surgical or percutaneous drainage

In younger children (age 0 to 4), _____ cancer is more common.

medullary

The branchial network consists of a series of six paired ___ ____ that are separated externally by five ectodermal lined ___ ___ (grooves) and internally by five endodermal lined pouches

mesodermal arches; branchial clefts

The submental triangle is a ___ ___ triangle.

midline unpaired

Most thyroglossal duct cysts present during the first decade of life as ___ or ___ ___ ____ masses in the anterior part of the neck.

midline; slightly off midline

Pleomorphic adenoma

minimally heterogeneous, hypoechoic mass with well-defined, lobulated borders, and mild internal flow.

Kawasaki disease

mucocutaneous lymph node syndrome

They typically present as slowly growing, nontender masses in the upper neck and usually are found in patients between 10 and 40 years of age.

branchial cleft cysts

With infection or hemorrhage, the walls of the cyst become irregular and thick, and the echogenicity of the fluid increases

branchial cleft cysts

Sonographic findings are typical of a ____, including well-defined borders, anechoic contents, posterior sound transmission, and no internal vascularity

cyst

The ____ ____ also become thicker with infection.

cyst walls - lymphangioma

Jugular vein varices are rare. Aneurysmal dilatation has been described in association with ___ ____

cystic hygroma

Large ___ ____ can extend into the mediastinum

cystic hygromas

Lymphangiomas, also termed ___ ____

cystic hygromas

They can be associated with Noonan, Turner, fetal alcohol, Robert, and trisomy 21, 13, and 18 syndromes.

cystic hygromas

In _____, the gland is smaller in size or volume than expected for age. These glands usually have an unusual shape, appearing round or blunted

hypoplasia

Pituitary secretion of TSH is in turn regulated by thyrotropin-releasing hormone (TRH), which is produced by the _____

hypothalamus

Hashimoto thyroiditis: Most patients are initially euthyroid and slowly become _____

hypothyroid

At sonography, uncomplicated branchial cleft cysts appear as ____ ____, thin walled, cystic masses

sharply marginated

Acinar cell carcinoma

shows an oval, heterogeneous, hypoechoic tumor with irregular borders; scattered internal vascularity

Recurrent ____ can be caused by ____, which most commonly affect the submandibular gland

sialadenitis; sialoliths

Other than the number of channels, the imaging features of the arteriovenous fistula and malformation are ____.

similar

There are two types of ranulas:

simple and plunging.

A branchial sinus opens externally to the ___ and a fistula communicates externally to the skin and ___ to the pharynx.

skin; internally

which is a normal finding and of no clinical significance.

small hypoechoic colloid follicles; The punctate echogenicity within the follicles is inspissated colloid

Normal parathyroid glands are almost never seen at sonography because of their _______________ and an echotexture that is similar to adjacent thyroid parenchyma.

small size (less than 5 mm in length)

The other vascular malformations are more likely to arise in the ___ ___ of the head or neck and are discussed in more detail in the section on neck masses.

soft tissues

Sonographic of thyroid cancer findings of a predominantly ____ ____, punctate calcifications (psammomatous calcifications), irregular, lobulated, or ill-defined margins, and a ____ or irregular hypoechoic rim are suggestive of malignancy

solid matrix; thick;

Spectral Doppler findings are spectral broadening (blunted systolic peaks) at the site of _____ and increases in the ICA peak systolic velocity, ICA end diastolic velocity (ESV), and internal carotid artery/common carotid artery PSV (IC/CC PSV) ratio.

stenosis

Anterolateral to each thyroid lobe are the ____________________.

sternocleidomastoid and strap muscles

Structures anterior to the ____ ___ lie within the anterior triangle and those behind the muscle lie within the posterior triangle.

sternocleidomastoid muscle

Traditionally, the neck has been divided by the ___ ___ into paired anterior and posterior triangles

sternocleidomastoid muscle

The echogenicity increases if the contents contain blood or protein.

thymic cyst

Most are located anterior to the ___ ___ sternocleidomastoid muscle, but they can extend posterior to it. They often splay the carotid artery and jugular vein and they can extend into the mediastinum.

thymic cysts

As the ____ descends from the neck into the mediastinum, it maintains a connection to the third branchial pouch. This connection, termed the ___ ____.

thymus; thymopharyngeal duct

As it descends caudally to reach its expected position in front of the larynx opposite C5-7, it retains its connection with the base of the tongue via a tubular stalk, known as the____ ____.

thyroglossal duct

Cysts below the hyoid bone may be midline or lateral to the midline in position.

thyroglossal duct cyst

Internal echogenicity, scattered septations, solid-appearing regions, and irregular walls can be seen in the presence of infection

thyroglossal duct cyst

Suprahyoid cysts are usually midline in location,

thyroglossal duct cyst

The sonographic appearance of an uncomplicated ___ ____ ___ is a well-defined thin-walled, anechoic mass with acoustic enhancement in a midline or just off midline position

thyroglossal duct cyst

The function of the _____ is to produce hormones that regulate cellular and physiologic activities, such as growth, development, and metabolism.

thyroid

The gland secretes two active hormones: T3 (triiodothyronine) and T4 (thyroxine)

thyroid

there is absence of thyroid tissue

thyroid aplasia

Sonography in ____ ____ shows an empty thyroid fossa.

thyroid ectopia

Occasionally, an extra lobe, the pyramidal lobe, extends superiorly from the isthmus or the adjacent part of either lobe. Typically, this lobe has a conical shape

thyroid gland

Similar to the thyroid gland, the migration of the parathyroid glands may be arrested or the glands may migrate below the level of the ____ ___ into the mediastinum.

thyroid gland

The ___ ___ is bordered posterolaterally by the common carotid artery and internal jugular vein and medially by the trachea on the right and esophagus on the left.

thyroid gland

The ____ ____ develops in the first trimester as a midline ventral outgrowth from the floor of the embryonic pharynx near the base of the tongue.

thyroid gland

The ____ ____ extends superiorly to the level of the thyroid cartilage and inferiorly to the level of the fifth or sixth tracheal rings, with the body of the gland at the level of the cricoid cartilage.

thyroid gland

The normal ____ _____ is a homogeneous bilobed structure that is slightly hyperechoic to adjacent neck muscles.

thyroid gland

The____ _____ is composed of paired right and left lobes, one on each side of the trachea, joined by an isthmus anteriorly.

thyroid gland

Venous drainage is through the ____ ___

thyroid veins.

Differentiation between a true cyst and an anechoic colloid cyst may require ____ _____.

tissue sampling.

Autonomously functioning nodules are also termed ____ ____ ____, or Plummer disease

toxic autonomous nodules

The anterior wall of the ____ appears as a well-defined echogenic band.

trachea

Carotid artery thrombus and stenosis are rare in children and usually are due to ____

trauma

The shape of the submandibular gland on longitudinal and transverse images is close to a ____.

triangle

Rare Neoplasms: Less common ___ include cystadenomas, Warthin tumors, lymphoepithelial tumors, neurofibromas, and xanthomas

tumors

For infants and young children, transverse, longitudinal, and anteroposterior dimensions are _____________________ respectively.

1 to 1.5, 2 to 3, and 0.2 to 1.2 cm,

Malignancies of the head and neck account for approximately ____ of pediatric malignancies

12%

The median interval from radiation therapy to diagnosis of thyroid cancer is approximately ____ _____

13 years

Congenital hemangiomas: RICH involute completely, usually by the age of____ , whereas NICH do not regress but grow in proportion with the child and may require ____.

14 months; excision

For adolescents and young adults, corresponding measurements are ___________________________

2 to 4, 5 to 8, and 1 to 2.5 cm.

These are hypoechoic and oval or longitudinal in shape, measuring less than _______in longest diameter, with a short axis to long axis ratio greater than 0.5

5 to 6 mm

Hodgkin and non-Hodgkin lymphomas account for about ______of pediatric neck malignancies

50% to 60%

ECA: Normal flow indices include PSV of _____ cm/s, EDV of ______ cm/s, and RI of _____.

57 to 87; 11 to 21; 0.72 to 0.84

ICA: Normal flow values include a peak systolic velocity (PSV) of _______ cm/s, end diastolic volume (EDV) of _____ cm/s, and RI of _______.

62 to 90; 23 to 27; 0.54 to 0.6

Once the gland reaches its final position in front of the trachea, at approximately_____________ the thyroglossal duct usually disappears.

7 weeks gestation,

parotid glands are superficial structures and are evaluated best with a high frequency, __________, linear or curvilinear array transducer, with or without a stand-off pad

7- to 15-MHz

common carotid artery: Normal values include a PSV of ______ cm/s, EDV of _____ cm/s, and RI of ____

78 to 118; 20 to 32; 0.72 to 0.84

The common clinical indications for sonography are

A. congenital thyroid anomalies (i.e., neonatal hypothyroidism) B. evaluation of a suspected thyroid nodule or mass C. assessment of an enlarged gland (goiter) D. evaluation of clinical findings of hypothyroidism or hyperthyroidism.

Congenital anomalies of the thyroid gland include:

A. dysgenesis (abnormality of structure), B. dyshormonogenesis (error in hormone synthesis and secretion), C. thyroglossal duct cys

Staphylococcus aureus and Streptococcal species are the common organisms.

Abscess formation: Staphylococcus aureus and Streptococcal species are the common organisms.

An occasional cause of infection is a congenital fistula between the pyriform sinus and the ipsilateral lobe of the thyroid gland or the perithyroidal space

Acute Suppurative (Bacterial) Thyroiditis

Sonographic findings are an enlarged gland, single or multiple hypoechoic or complex masses representing abscess formation, and hypervascularity on Doppler imaging. Abscess and cellulitis may be seen in the perithyroid tissues.

Acute Suppurative (Bacterial) Thyroiditis

The common inciting organisms are Streptococcus hemolyticus and Staphylococcus pneumoniae.

Acute Suppurative (Bacterial) Thyroiditis

_____ ____ ____ is rare and usually is seen in neonates and immunosuppressed children

Acute bacterial parotitis

With increasing age, the incidence of papillary histology increases. ____ _____ and ____ are extremely rare in children.

Anaplastic carcinoma; sarcomas

Clinical findings include a pulsatile mass with a bruit or thrill.

Arteriovenous malformations

____ ____ are high flow anomalies characterized by an abnormal connection between arteries and veins and absence of a capillary network. Instead, a network of small vessels (the nidus) is interposed between the supplying artery and draining vein

Arteriovenous malformations

____ ____ appear as unilocular, smooth-walled, anechoic lesions with through sound transmission

Parathyroid cysts

____ ____ include follicular adenoma, hyperplastic nodules, and nodules in Graves disease

Benign nodules

slow growing, hard, painless masses.

Benign tumors

___ ___ ____ are the most common brachial apparatus anomaly.

Brachial cleft cysts

a young girl with a painless neck mass below the left ear shows a thin walled cyst; anterolateral to the common carotid artery

Branchial cleft cyst

mass below the left ear; The cyst is lateral to the carotid artery. typical of this anomaly.

Branchial cleft cyst

__________ usually present as painless, fluctuant swelling, but they can be painful if they are infected

Branchial cleft cysts

___ ___, sinuses, or ____ develop when there is failure of obliteration of the branchial apparatus.

Branchial cysts; fistulas

___ ___ may compress the trachea, causing stridor.

Bronchogenic cysts

____ of the cartilage increases with age and can appear as bright, nonshadowing, small echogenic foci or as larger echogenic areas that cast an acoustic shadow.

Calcification

____ are most common in papillary and medullary cancers.

Calcifications

hemorrhage or necrosis: ______, which are usually curvilinear and peripheral, a pattern referred to as "eggshell" ____, may be present also. A vascular rim and central vascularity may be noted on Doppler imaging

Calcifications; calcification

Sonography is usually normal, although increased thickness of the subcutaneous fat and prominent venous channels may be seen in some patients.

Capillary malformations (i.e., port wine stain)

____ _____ are characterized by a collection of small vascular channels in the dermis.

Capillary malformations (i.e., port wine stain)

____ ____ _____ can result from an arteritis, including Kawasaki disease, Takayasu disease and giant cell arteritis, Langerhans histiocytosis, infection, trauma, or catheterization.

Carotid artery aneurysms

A historical cause is extracorporeal membrane oxygenation (ECMO)

Carotid artery thrombus and stenosis

When this procedure was described initially, perfusion cannulas were placed in the right jugular vein and in the right common carotid artery. After the cannulas were removed, the carotid and jugular vessels were ligated. Currently, ECMO is performed via direct cannulation of the superior vena cava and aortic arch, so that carotid artery thrombosis and stenosis are no longer complications of the procedure

Carotid artery thrombus and stenosis

____ involvement is more common in Hodgkin than in non-Hodgkin lymphoma.

Cervical

color Doppler views show a well-defined hypoechoic mass (arrows) with internal debris and peripheral flow. The central hilar stripe is absent. Surrounding soft tissues are thickened and edematous. Cultures from percutaneous aspirate grew Staphylococcus aureus.

Cervical abscess

____ ____ nodes may mimic parathyroid adenomas. Lymph nodes have echogenic, vascular centers, and commonly are found beneath the thyroid gland.

Cervical lymph

Sources of infection include upper respiratory tract infections, tonsillar and pharyngeal infections, and recent dental work

Cervical lymphadenitis

___ ____ is a common pediatric problem and may be caused by viral (commonly adenovirus and enterovirus) or bacterial infections (commonly Staphylococcus or Streptococcus species)

Cervical lymphadenitis

____ ____ is a common manifestation in children who are positive for HIV.

Cervical lymphadenopathy

_____ _____ typically presents as an asymptomatic soft tissue mass in the posterior neck, but the lesion may present as a painful mass due to inflammation or hemorrhage.

Cervical lymphangioma

Treatment includes surgical resection or debulking, sclerotherapy, and interferon injection.

Cervical lymphangioma - Large cystic hygromas

a palpable left neck mass. Longitudinal view of the neck shows a large, heterogeneous mass. The sonographic features are nonspecific and mimic other soft tissue masses.

Cervical rhabdomyosarcoma

Large lesions may cause stridor, dyspnea, or dysphagia

Cervical teratomas

____ _____ are typically large bulky masses that are discovered at birth or in the first year of life

Cervical teratomas

Most present as slowly enlarging, nontender masses in the lower third of the lateral neck, although they can occur anywhere in the neck from the angle of the mandible to the sternum.

Cervical thymic cysts

The cysts occur more often on the left than the right side.

Cervical thymic cysts

___ ____ ____ develop from vestiges of the thymopharyngeal ducts or from areas of cystic degeneration of the thymus gland.

Cervical thymic cysts

___ ___ ____ is characterized by intermittent, unilateral, or bilateral swelling of the salivary glands, which can be accompanied by pain and fever

Chronic recurrent sialadenitis

previous indwelling catheter show multiple collateral vessels with internal flow in the lateral neck. Flow is absent in the jugular vein due to occlusive thrombus.

Chronic venous thrombosis

They are thought to be the result of cycles of hyperplasia and involution of thyroid follicles.

Colloid cysts

____ ___ are composed primarily of colloid and scant follicular cells.

Colloid cysts

____ ____commonly are seen in the parenchyma, appearing as small anechoic areas (< 1 cm in diameter)

Colloid follicles

___ ____ are not positive for the GLUT-1 marker

Congenital hemangiomas

are present and fully grown at birth.

Congenital hemangiomas

with a midline neck mass just below the thyroid cartilage; a hypoechoic mass with internal echoes and well-defined, smooth borders; Color Doppler sonogram shows absence of internal vascularity. Pathologic examination demonstrated keratinous debris.

Dermoid cyst

____ ____ are slowly expanding masses that commonly present as midline neck masses in the submandibular or sublingual spaces, suprasternal notch, or periorbital area

Dermoid cysts

sonography, they appear as well-defined, homogeneous masses that are isoechoic or hypoechoic to adjacent soft tissues Calcifications can be present in the wall.

Dermoid cysts

_____ is a less frequent cause of neonatal hypothyroidism (10% to 15% of cases) and is an abnormality of one or more of the enzymes involved in the pathway of thyroid hormone synthesis and secretion.

Dyshormonogenesis;

midline mass in the lower neck. Transverse view just above the sternoclavicular notch shows a well-defined cystic mass with low-level internal echoes secondary to proteinaceous contents.

Ectopic bronchogenic cyst

It usually extends anteromedial to the carotid sheath and has no connection with mediastinal thymic tissue

Ectopic thymic

____ ____ tissue is isoechoic or hypoechoic to muscle, has linear or punctate echogenic foci characteristic of normal thymus, and shows mild to moderate vascularity

Ectopic thymic

mass with multiple punctate hyperechoic foci typical of thymus medial to the right common carotid artery and inferior to the right lobe of the thyroid gland Histologic examination demonstrated hyperplastic ectopic thymus.

Ectopic thymus

____ _____ tissue is the most frequent form of dysgenesis and, as such, the most common congenital cause of congenital hypothyroidism. Arrest in descent of the thyroid anlage results in ____ _____ tissue.

Ectopic thyroid; ectopic thyroid

____ ____ ____ as hypoechoic oval structures with linear hyperechoic hila. The short axis to long axis ratio is 0.5 or less. Color Doppler imaging shows central vascularity. The differential diagnosis of enlarged nodes with a visible hilum is lymphoma.

Enlarged nodes appear

___ ____ ___ waveform shows a higher resistance profile with a narrow systolic peak, rapid decline toward baseline, and lower diastolic flow. Transient reversal in early diastole can be seen normally.

External carotid artery

enlarged thyroid gland on physical examination; enlarged right lobe of the thyroid gland; echogenicity is normal. The left lobe had a similar appearance.

Goiter due to congenital error in hormone synthesis.

Color Doppler imaging shows marked hypervascularity (termed the thyroid inferno), arteriovenous shunting, and high systolic and diastolic flow velocities, ranging between 50 and 120 cm/s

Graves disease

Serum T4 and T3 levels are increased and TSH levels are decreased.

Graves disease

The clinical findings of ____ ____ include diffuse thyroid gland enlargement (goiter) and thyrotoxicosis manifested by jitteriness, nervousness, weight loss, sweating, palpitations, heat intolerance, infiltrative ophthalmopathy (proptosis), and, rarely, infiltrative dermopathy.

Graves disease

The echogenicity may be normal or hypoechoic. Nodule formation, although not as common as in Hashimoto disease, occasionally can occur

Graves disease

The sonographic findings include glandular enlargement, heterogeneous echotexture, and lobulated contours

Graves disease

___ ____ is more frequent in girls than boys and peaks in adolescence

Graves disease

also called diffuse toxic goiter

Graves disease

It is an autoimmune disease caused by thyroid-stimulated immunoglobulin that binds to the TSH receptors, leading to increased synthesis of TSH

Graves disease - toxic goiter

the most common cause of hyperthyroidism in the pediatric age group

Graves disease - toxic goiter

Sonographically, the parotid glands are enlarged and heterogeneous with multiple cysts or cystic and solid areas that are surrounded by thickened septa. Doppler imaging shows increased blood in the soft tissue components. Associated cervical lymphadenopathy is common.

HIV infection The sonographic pattern reflects the presence of lymphoid infiltration and lymphoepithelial cysts

Calcifications may be seen. Multiple enlarged cervical lymph nodes are also a common finding.

Hashimoto thyroiditis

Early in the disease, serum thyroxine levels are normal and eventually become low. Levels of TSH are increased.

Hashimoto thyroiditis

In early disease, diffusely increased flow is noted on color flow imaging. In end stage disease, the gland is small and hyperechoic, reflecting atrophy and fibrosis, and Doppler imaging may show diminished flow.

Hashimoto thyroiditis

Increased in patients with chromosomal disorders, including Turner, Down, Klinefelter, and Williams syndrome, and in those with treated Hodgkin disease

Hashimoto thyroiditis

It is the most common thyroiditis in children and the most common cause of acquired hypothyroidism

Hashimoto thyroiditis

The characteristic serologic finding is the presence of high serum levels of antibodies to TG and TSH receptors.

Hashimoto thyroiditis

The common pathologic feature is lymphocytic infiltration and atrophic or fibrotic follicles.

Hashimoto thyroiditis

There is also an association with autoimmune diseases, including rheumatoid arthritis, lupus erythematosus, and Jorgenson syndrome, and with other endocrine disorders, including Addison disease, hypoparathyroidism, and diabetes mellitus

Hashimoto thyroiditis

autoimmune thyroiditis and chronic lymphocytic thyroiditis, is an organ-specific autoimmune disease occurring most frequently in adolescent girls and women over 40 years of age.

Hashimoto thyroiditis

enlarged right lobe of the thyroid gland (calipers) with multiple small, hypoechoic nodules; Color Doppler image shows increased vascularity.

Hashimoto thyroiditis

_____ is the most common vascular tumor of infancy.

Hemangioma

_____ ____ are usually the result of bleeding into a follicular adenoma or colloid cyst.

Hemorrhagic cysts

scan below the chin shows a hypoechoic mass representing the thymus anterior to the thyroid gland; with the thymus in the superior mediastinum. Again note the echogenic foci typical of normal thymus.

Herniated mediastinal thymus

lymphoma: Sonographic findings of thyroid irradiation in children with ____ ___ include solitary or multiple nodules, parenchymal ____, and parenchymal heterogeneity with ______.

Hodgkin diseasel; atrophy; calcifications

_____ lymphoma tends to affect children in the second decade of life, while _____ lymphoma can occur throughout childhood.

Hodgkin; non-Hodgkin

ptosis, myosis, and anhidrosis

Horner syndrome

Enlarged, heterogeneous right parotid gland containing multiple hypoechoic foci, corresponding to lymphoid infiltration and lymphoepithelial cysts. Color Doppler image shows marked hyperemia

Human immunovirus infection

a solid nodule with well-defined margins and a thin hypoechoic rim. Doppler sonogram shows central and peripheral flow.

Hyperplastic nodule

Sonographic findings are a hyper-, iso-, or hypoechoic nodule with well-defined margins and a halo

Hyperplastic nodules

____ _____ are composed of follicles, colloid, and varying amounts of fibrosis and are usually unencapsulated.

Hyperplastic nodules

Although they maybe solitary, they often are multiple and found in the setting of multinodular goiter.

Hyperplastic or Adenomatoid Nodule

Patients present with symptoms of weight loss, heat intolerance, tachycardia, palpitations, diarrhea, goiter, or exophthalmos

Hyperthyroidism

The common causes are Graves disease and other autoimmune disorders (lupus, rheumatoid arthritis, and Sjögren syndrome)

Hyperthyroidism

___ is secondary to overproduction of thyroid hormone.

Hyperthyroidism

_____ results from inadequate production of thyroid hormones.

Hypothyroidism

Focal areas of increased echogenicity may be observed secondary to vessel thrombosis or calcification

Infantile hemangiomas

In the neck, they usually are located in the anterior compartment.

Infantile hemangiomas

Most are clinically evident before patients are 6 months of age, presenting as soft masses with red or blue discoloration and occasionally audible bruits.

Infantile hemangiomas

Sonography shows an enlarged, heterogeneous parotid gland

Infantile hemangiomas

They may be associated with other cutaneous hemangiomas, hemangiomas in solid organs, and a spectrum of anomalies referred to as the PHACE syndrome, defined by Posterior fossa malformations, Hemangiomas, Arterial lesions, Cardiac defects, and Eye abnormalities

Infantile hemangiomas

____ ____ are characterized by a rapid growth phase after birth followed by slow involution in early childhood.

Infantile hemangiomas

___ ____can show flow in the wall of the cyst or in surrounding soft tissues.

Infected cysts

image just beneath the chin in a 5-year-old girl shows a midline cystic mass with internal echoes.

Infected thyroglossal duct cyst

acute infection: ___ ___ are the common cause of salivary gland enlargement in children.

Inflammatory lesions

____ ____ ____ shows a low-resistance waveform with a sharp systolic upstroke, blunted systolic peak, and gradual tapering of continuously forward flow throughout diastole.

Internal carotid artery

prior left neck injury; Left ICA, Longitudinal image shows aliasing (more than two colors of the Doppler spectrum); Peak systolic velocity flow 180 cm/s and diastolic velocity 38.1 cm/s;

Internal carotid artery (ICA) stenosis

_____ disease also can present with acute cervical lymphadenitis, but other findings, such as rash and fever, are also present

Kawasaki

Noninfectious causes include sinus histiocytosis with massive lymphadenopathy, ______ _____, Langerhans histiocytosis, and sarcoidosis.

Kawasaki disease

The syndrome follows a primary oropharyngeal infection and results in a tonsillar or peritonsillar abscess, jugular venous thrombosis, and septic emboli

Lemierre syndrome

A rare cause of jugular thrombophlebitis is _____ syndrome, caused by ____ _____, a gram-negative anaerobic organism that normally inhabits the oropharynx.

Lemierre; Fusobacterium necrophorum

____ is well-defined, often with a lobular appearance and internal septations.

Lipoblastoma

______ is a rare benign mesenchymal tumor of embryonal white fat that occurs in infancy and early childhood

Lipoblastoma

hypoechoic mass with central echogenicity representing fat. Enlarged reactive nodes are seen adjacent to the mass. Pathologic examination shows a lipoblastoma with a predominance of myxoid components.

Lipoblastoma

These lesions most frequently affect the upper back, neck, proximal extremities (particularly the shoulder), and abdomen.

Lipomas

They typically manifest as a discrete, mobile soft mass.

Lipomas

_____ are usually superficial and arise in the subcutaneous

Lipomas

____ _____ is more difficult to diagnose than adenomas.

Multiglandular hyperplasia

Most of the nodules are hyperplastic or adenomatous with varying degree of cystic degeneration.

Multinodular Goiter - nodular hyperplasia

The thyroid gland is enlarged and has smooth borders and a heterogeneous texture with multiple nodules, which often are cystic

Multinodular goiter

Tiny, nonshadowing, bright reflections in the cystic spaces due to inspissated colloid or shadowing reflections due to calcifications may be noted. Doppler sonography may show peripheral vascularity around the nodules and intranodular vascularity (mostly in solid hyperfunctioning nodules).

Multinodular goiter

____ ____ may be sporadic, congenital due to defects in thyroid synthesis, or secondary due to inadequate dietary iodine intake (endemic goiter)

Multinodular goiter

Affected patients usually present with a nontender, palpable, rubbery, firm to hard nodule or mass in the skin, muscle, or subcutaneous tissues

Myofibromatosis

At sonography, the lesions have the nonspecific appearance of a hypoechoic to isoechoic mass.. Echogenic foci with posterior acoustic shadowing, corresponding to calcification, also may be seen. Doppler findings are variable

Myofibromatosis

The multicentric form also involves viscera (lung, heart, gastrointestinal tract, and pancreas)

Myofibromatosis

The solitary form most frequently affects the head and neck region, followed by the trunk and then the extremities.

Myofibromatosis

_____ is the most common fibroblastic-myofibroblastic soft tissue tumor of childhood

Myofibromatosis

______ almost exclusively occurs in patients less than 2 years of age.

Myofibromatosis

with an enlarging, firm neck mass without torticollis; large, heterogeneous mass in the sternocleidomastoid muscle and lateral to the left lobe of the thyroid gland. olor Doppler image shows the enlarged sternocleidomastoid muscle that has moderate internal vascularity. Punctate echogenic foci represent calcifications. The age of the patient at presentation helps to differentiate this from fibromatosis colli.

Myofibromatosis

patient breathing quietly shows a pulsatile waveform, reflecting cardiac contractions

Normal internal jugular vein

<10 mm in short axis diameter, can be seen in the neck of asymptomatic children, particularly around the carotid artery and jugular vein.

Normal lymph nodes

They appear as flattened or oval, hypoechoic structures with an echogenic linear hilum, which is vascular on color Doppler imaging. The length exceeds the width by approximately 2:1.

Normal lymph nodes

facial nerve weakness or paralysis, fixation to skin, or deep tissues and lymphadenopathy.

Other clinical features of malignant lesion

___ ____ also have been associated with abnormalities on chromosome arm 10q, familial adenomatosis polyposis, and Cowden disease (also known as multiple hamartoma syndrome).

Papillary cancers

a complex, solid mass in the right thyroid lobe containing punctate echogenic foci representing calcifications. Punctate calcifications are highly suggestive of malignancy.

Papillary thyroid cancer.

____ ____ commonly show flow on color Doppler imaging, although the vascularity of small lesions may be difficult to detect.

Parathyroid adenomas

an oval, hypoechoic mass behind the right lobe of the thyroid gland.. Color Doppler sonography shows a vascular rim around the adenoma with a feeding polar artery

Parathyroid adenomas

renal osteodystrophy and secondary hyperparathyroidism. Right panel, right superior gland. Left panel, left inferior gland. The echogenicity is less than that of adjacent thyroid. All four parathyroid glands were enlarged.

Parathyroid hyperplasia

___ ____ occurs in up to 30% of children with HIV infection and is usually bilateral

Parotid involvement

submandibular gland; oval, hypoechoic, heterogeneous mass with well-defined margins and minimal vascularity

Pleomorphic adenoma

Color Doppler imaging shows mild or moderate vascularity, which can have a central, peripheral, or combined distribution

Pleomorphic adenomas

___ ____, as well as other benign salivary gland tumors, tend to be round or oval, hypoechoic, homogeneous to slightly heterogeneous masses with well-defined, smooth, or lobulated margins

Pleomorphic adenomas

____ ____ may have more irregular contours, infiltrate soft tissues, and cross the midline

Plunging ranulas

_________ cancers have a higher frequency of multicentricity and bilateralness.Color Doppler imaging can show increased internal or_____ flow.

Radiation-related; peripheral

___ ___ ___ may be tender or painful on palpation.

Rapidly growing tumors

____ ____ ____ ____, encasement of adjacent vessels, and invasion of surrounding soft tissues are other findings suggesting malignancy of a tumor.

Regional lymph node enlargement

Disease incidence is bimodal, with one peak occurring between 2 and 6 years of age and the second between 10 and 18 years.

Rhabdomyosarcoma

Is the most common soft tissue sarcoma of childhood, and 35% to 40% of all rhabdomyosarcomas arise in the head and neck

Rhabdomyosarcoma

Most patients present with an enlarging painless mass. Common sites of metastases are lung, bone, bone marrow, lymph node, brain, and liver.

Rhabdomyosarcoma

____ accounts for 10% to 15% of cervical tumors.

Rhabdomyosarcoma

Sonographic findings include dilated ducts and highly echogenic foci with distal acoustic shadowing

Sialolithiasis

The common symptom is painful enlargement of the salivary gland.

Sialolithiasis

Autoimmune diseases

Sjögren syndrome granulomatous diseases, including sarcoidosis, tuberculosis, and cat-scratch fever, are rare causes of sialadenitis in children.

Sonographic features of ____ ____and ____ ____ are an enlarged or normal sized gland with heterogeneous parenchyma containing multiple hypoechoic areas and hypervascularity on Doppler imaging

Sjögren syndrome; granulomatous sialadenitis

Occasionally, the paired superior and inferior thyroid arteries (< 2 mm diameter), which supply the gland, can be seen entering the parenchyma.

Small vessels are noted in the parenchyma

Histologic examination reveals granulomas and epitheloid cells. Patients present with fever, painful thyroid enlargement, and signs of thyrotoxicosis. Serum T3 and T4 levels and thyroid peroxidase antibodies are elevated; TSH levels are decreased

Subacute granulomatous thyroiditis - de Quervain thyroiditis

Sonographic findings include glandular enlargement, heterogeneous echotexture with ill-defined regions of decreased echogenicity, and no flow on Doppler imaging

Subacute granulomatous thyroiditis - de Quervain thyroiditis

_____ ____ thyroiditis (also called de Quervain thyroiditis) is a transient inflammatory disease, usually preceded by an _____________________________________

Subacute granulomatous;upper respiratory viral infection

midline well-defined cystic mass; anterior to the left lobe of the thyroid gland

Subhyoid cyst.

____ ____ usually are located in the superior mediastinum close to the thymus

Supernumerary glands

High levels of circulating thyroid hormones inhibit ____ ____ _____ secretion, and low levels stimulate their secretion

TSH and TRH

a cervical mass seen on a fetal sonogram; heterogeneous mass; with multiple anechoic areas and a hyperechoic area with acoustic shadowing representing calcification; Color Doppler sonogram demonstrates an avascular mass.

Teratoma

cystic mass below the right lobe of the thyroid gland; cystic mass arising from the superior mediastinum and extending into the base of the neck.

Thymic cyst

Ductal enlargement occurs as a result of accumulation of secretions produced by the epithelial lining

Thyroglossal duct cysts

The cysts may contain ectopic thyroid tissue anywhere along the course of the duct.

Thyroglossal duct cysts

They arise from remnants of the embryonic thyroglossal duct that connects the foramen cecum at the base of the tongue to the thyroid gland.

Thyroglossal duct cysts

Treatment is surgical resection because of the risk of infection and malignancy, most commonly papillary carcinoma

Thyroglossal duct cysts

___ ___ ___ are midline lesions found in the anterior neck.

Thyroglossal duct cysts

they move with swallowing

Thyroglossal duct cysts

midline cystic mass;

Thyroglossal duct cysts - Suprahyoid cyst

___ ____ is rare in children, constituting 1% to 1.5% of all malignancies before the age of 15 years

Thyroid cancer

____ _____ refers to a developmental defect of thyroid morphogenesis and is the most common cause of neonatal hypothyroidism, accounting for about 90% of cases

Thyroid dysgenesis

____ _____ is a rare congenital anomaly in which one lobe of the thyroid fails to develop. It is more common in female than male patients and is nearly always a ____ lobe defect. The isthmus also often is absent

Thyroid hemiagenesis; left

_____ ____ (TPO) oxidizes iodide into its chemically active form. Within the gland, thyroid hormones are stored in thyroglobulin (TG). In the circulation, carrier proteins transport thyroid hormones. These include thyroid binding globulin, thyroid binding preglobulin, and albumin.

Thyroid peroxidase;

Sublingual gland

Transverse sonogram shows the normal oval shape of the sublingual gland and increased echogenicity relative to adjacent digastric, geniohyoid, and genioglossus muscles

the left neck demonstrates multiple hypoechoic nodes with central echogenic hila. Differentiation from bacterial infection requires tissue sampling

Tuberculous adenopathy

_____ lesions are classified as hemangiomas or vascular malformations.

Vascular

____ _____ include arteriovenous, venous, capillary, and lymphatic malformations (cystic hygroma)

Vascular malformations

___ ___ may involve skin, muscle, or both tissues.

Venous malformation

On sonography, they are usually hypoechoic but they may be isoechoic or hyperechoic to subcutaneous soft tissues. Doppler evaluation demonstrates either low-resistance monophasic venous flow or no flow. The absence of flow may reflect thrombosis. Intralesional phleboliths may be seen.

Venous malformations

They typically present as superficial, compressible masses with bluish discoloration of the overlying skin.

Venous malformations

___ ____ are slow-flow vascular lesions characterized by dysplastic venous spaces and a normal arterial component.

Venous malformations

The submandibular gland is drained by the ____ ___, which courses between the mylohyoid muscle laterally and hypoglossus muscle medially.

Wharton duct

when a branchial cleft does not completely involute, a ___ ____ ____ can form.

branchial cleft cyst

The major complication of cervical adenitis is ____ formation.

abscess

The sonographic findings of____ are a hypoechoic mass with variable wall thickness and associated soft tissue thickening. The central hilar stripe is absent. Internal echoes, representing purulent material and debris, and septations are common. Color Doppler imaging shows peripheral flow, Flow is not demonstrable within the central cavity.

abscess

At sonography, _____ appear as round or oval hypoechoic masses with well-defined walls and internal septations, debris, or fluid-fluid levels

abscesses

The substance of the gland contains ____ that are drained by small ducts, which in turn drain into the larger duct of ____

acini; Stensen

The sonographic findings of _____ ____ _____ are echogenic material filling the lumen and the absence of flow on pulsed and color flow Doppler imaging

acute arterial thrombosis

Common viruses include cytomegalovirus, Coxsackie virus, Epstein-Barr virus (infectious mononucleosis), and human immunodeficiency virus (HIV).

acute infection/ inflammatory lesions

Mumps virus can be a cause in individuals who have not been immunized with mumps vaccine.

acute infection/ inflammatory lesions

patients present with painful swollen salivary glands

acute infection/ inflammatory lesions

Rarely, _____ appear entirely cystic, contain calcifications, or have a multilobulated configuration.

adenomas

At sonography, _____ are usually solitary, well-defined, _____ to minimally heterogeneous nodules with a thin (1- to 2-mm) hypoechoic "halo" or rim caused by the ____ ____, compressed thyroid parenchyma, or pericapsular inflammatory infiltration.

adenomas; homogeneous; fibrous capsule

Intensely echogenic, mobile foci with dirty shadowing are highly suggestive of ___.

air

Doppler spectrum with red, yellow, green, and blue colors

aliasing

The isthmus is _____ to the trachea and the ____ _____, when present, extends superiorly

anterior; pyramidal lobe;

The four types of dysgenesis are

aplasia, hemiagenesis, hypoplasia, and ectopia

The _____ ____ is a form of arteriovenous malformation, which has a single communication interposed between a feeding artery and a draining vein.

arteriovenous fistula

At sonography, ___ ___ appear as a collection of anechoic spaces with poorly defined walls.

arteriovenous malformations

Doppler imaging shows a mass of vessels with arteriovenous shunting characterized by low-resistance arterial blood flow, high diastolic flow (resistive index [RI] < 0.5), and pulsatile venous flow (arterialized waveforms in the draining veins). A surrounding soft tissue component is absent, which helps to separate this lesion from the hemangioma

arteriovenous malformations

Vascular malformations are a spectrum of lesions that include ____, ____, ____, and ____ malformations

arteriovenous; venous; capillary; lymphatic

Thyroglossal duct cysts are ____ unless infected

avascular

Approximately 90% of branchial abnormalities arise from the second ___ ___

branchial cleft

Abscess formation occurs in ____ infections

bacterial

Acute suppurative thyroiditis is rare and the result of ____ _____ of the gland.

bacterial infection

Thyroglossal duct cysts: Approximately 65% are located ___ the level of the hyoid bone, 20% are ____ and 15% are at the level of the ___ bone

below; suprahyoid; hyoid

Congenital lesions and lymphadenopathy account for nearly all ____ neck lesions

benign

The thickness and volumes of the thyroid lobes have been reported as a function of ________________________

body height and age

The ___ _____ develops during the second to sixth weeks of fetal life, forming four arches, clefts, and pouches.

branchial apparatus

Pleomorphic adenomas: However, they can contain anechoic cystic spaces, secondary to hemorrhage or cystic degeneration, and hyperechoic foci, corresponding to ____

calcifications

The parathyroid glands secrete parathyroid hormone (PTH) and are responsible for maintaining ____ ___ ____ homeostasis.

calcium and phosphate

The ____________________________ are scanned with the neck extended and the head turned away from the side being examined.

carotid artery and jugular vein

The common carotid artery and internal jugular vein, lying within the ___ ___, are anechoic structures, with the walls of the carotid artery being more ____ than those of the jugular vein.

carotid sheath; echogenic

trachea: The posterior cartilaginous wall is obscured by air in the trachea, but the ___ ____ ____ can be visualized in transverse and sagittal planes

cartilaginous cricoid ring

caused by Bartonella henselae, a gram-negative bacillus

cat-scratch disease

Lymph node enlargement has been correlated with decreasing CD4 lymphocyte counts.

children who are positive for HIV

Sonography shows multiple enlarged, hypoechoic lymph nodes. Of note, nodal enlargement in patients with acquired immunodeficiency syndrome (AIDS) also can be due to non-Hodgkin lymphoma.

children who are positive for HIV

The lymphadenopathy is usually symmetric, painless, and extensive. Affected children may present with parotid gland enlargement caused by lymphocytic infiltration

children who are positive for HIV

Carotid artery thrombus and stenosis Findings of ____ _____ include small vessel size, hypoechoic intraluminal clot, and collateral vessel formation.

chronic occlusion

Findings of ____ _____ are hypoechoic or anechoic clot related to red blood cell lysis and collateral vessel formation

chronic thrombosis

At sonography, ____ ____ can appear anechoic or they may contain internal echoes or septations, including bright foci with comet-tail artifacts caused by the presence of microcrystals

colloid cysts

The _____ _____ ______ has characteristics of both the internal and external carotid arteries, but because 70% to 80% of its flow goes to the internal carotid artery, the common carotid artery waveform tends to be more similar to the internal-____ carotid artery waveform than the external carotid waveform.

common carotid artery; internal;

The hemorrhage may occur spontaneously or as the result of blunt trauma to the neck. The acute lesion appears as a _____________________________________ or debris and irregular walls. Over time, the lesion becomes ______ and develops a more circumscribed border. The _____ may or may not persist, and a fluid-fluid level can develop.

complex mass with internal septations; hypoechoic; septations

Neck masses fall into one of three categories:

congenital/developmental, neoplastic, inflammatory/reactive

The external carotid artery runs in a ____ plane, close to the medial border of the gland.

deeper

Benign lesions can have an aggressive appearance and malignant lesions can have features suggesting a benign nodule, so tissue sampling is required for a ___ ___.

definitive diagnosis

The ___ ___ is a unilocular sac lined only by ectodermal tissue (i.e., skin, hair follicles, sweat glands, and sebaceous glands).

dermoid cyst

The importance of these nodes lies in the fact that they ____ the nasopharynx, oropharynx, tonsils, hypopharynx, and larynx and are the ones most often involved by ___ processes

drain; disease

Clinical findings of _______ are a palpable enlarged thyroid gland, the result of increased levels of TSH. Sonography shows an enlarged, normally positioned thyroid with convex lateral borders. The echogenicity is normal (

dyshormonogenesis

A cyst: On occasion, the contents are ___ due to hemorrhage or infection

echogenic

Lymphangiomas: The fluid components may appear ____ if there is superimposed hemorrhage or infection.

echogenic

ranulas: The contents may be ___ if they are infected.

echogenic

A less common indication is diagnosis of venous ___. The clinical indication for sonography of the carotid artery is suspected ________________.

ectasia; occlusion or stenosis

Other sites of _____ include the mediastinum, heart, esophagus, and diaphragm

ectopia

Decreased levels of thyroid hormones and elevation of TSH usually are less marked in cases of thyroid ___________________________

ectopia than in aplasia.

Most patients are asymptomatic; hoarseness, dysphagia, and stridor can occur

ectopic thymus

The _____ ____ presents as a midline or lateral neck mass (34,35) and is slightly more common on the right than the left.

ectopic thymus

Failure of complete descent of the embryonic thymus can result in an ___ ___

ectopic thymus.

The ____ _____ tissue usually is located close to the hyoid bone, but it can be found in the sublingual or prelaryngeal area.

ectopic thyroid

parathyroid adenomas can be ____ arising in the mediastinum or thyroid gland. Other causes of hyperparathyroidism are a functioning parathyroid __________________________

ectopic; carcinoma and a parathyroid cyst.

branchial apparatus

embryologic precursors that develop into the tissues of the neck.

In all these diseases, the nodes are ___ ____ ____ and may have a heterogeneous or homogeneous matrix, indistinguishable from infectious or neoplastic causes of lymph node enlargement. The ____ hilum may or may not be present

enlarged and hypoechoic; echogenic

Other infectious causes of ___ ____ ____ include mononucleosis and cat-scratch disease

enlarged cervical nodes

The sonographic findings of acute nonsuppurative viral inflammation are an _________________________. Additional findings : hypoechoic nodules, representing enlarged intraparotid nodes and hypervascularity at Doppler imaging

enlarged, heterogeneous gland

Sonographic findings of acute thrombosis are an _______, _____ jugular vein with low-level intraluminal echoes, absent or diminished flow on Doppler imaging, and loss of cardiorespiratory phasicity.

enlarged, noncompressible;

The sonographic findings of Hashimoto thyroiditis include glandular _____, parenchymal _____, and hypoechoic nodules, reflecting the infiltration by ____ ___ and follicular degeneration

enlargement; heterogeneity; lymphoid tissue

The ____ ____ is often a hereditary trait. The most common defect is thyroid peroxidase deficiency, which results in a failure of oxidation of iodide to iodine. Iodide is trapped but not organified.

enzymatic defect;

True _______________________ are rare, accounting for about 1% of thyroid masses. They are anechoic with smooth walls and through sound transmission, and are avascular on Doppler imaging.

epithelial-lined simple cysts

de Quervain thyroiditis: The pattern usually reverts to normal as the patient becomes ______.

euthyroid

Findings that are more indicative of a benign lesion include ____ ____ ____ (usually seen in adenomas or colloid cysts), peripheral rim-like _____, comet-tail artifacts, and avascularity. However, there is overlap in the sonographic features of benign and malignant nodules, and definite diagnosis requires _____

extensive cystic components; calcifications; biopsy

The ___ ____ ___ supplies the gland and the retromandibular (posterior facial) vein drains it.

external carotid artery

The superficial group of nodes follows the course of the ___ ____ ____.

external jugular vein

parathyroid adenoma: A characteristic finding is an ____ _____ ____ (typically arising from the inferior thyroidal artery), that enters the parathyroid gland at one of the poles.

extrathyroidal feeding vessel

Thyroid cancer: There is a ____ predominance (81% of patients), with a peak incidence between 7 and 18 years

female

Infectious Conditions Acute Suppurative (Bacterial) Thyroiditis: Children with suppurative thyroiditis are usually between 2 and 12 years of age and present with ____ ____ ____ thyroid enlargement. They are usually _____.

fever and painful; euthyroid

When both the branchial pouch and branchial cleft fail to involute, a ___ or ____ can form.

fistula; sinus

Acute Suppurative (Bacterial) Thyroiditis: Congenital ____ are more common on the left than on the right side.

fistulas

Graves disease: Pathologically, there is diffuse hyperplasia of ____ _____ _____, depletion of colloid, and increased vascularity.

follicular epithelial cells

here are more than ___ parathyroid glands.

four

The superior glands arise from the ____ ____ ____ and are located near the mid portion of the thyroid gland.

fourth branchial pouch

Sonographic findings include ___ ____ _____ dilatation of a segment of the carotid artery, intraluminal thrombus, and displacement of surrounding structures

fusiform or saccular

Infantile hemangiomas are positive for a _________________ marker.

glucose transporter 1(GLUT-1)

Lipoma and Lipoblastoma: These myxoid areas are ____ at sonography

hypoechoic

Parenchymal diseases that cause thyroid enlargement, also referred to as a ____, include inflammatory conditions, such as acute suppurative and subacute _____, autoimmune processes including ____ thyroiditis and ____ disease, and multinodular goiter.

goiter; thyroiditis; Hashimoto; Graves

Arteriovenous shunting is absent.

hemangiomas

Hypervascularity, a high systolic and diastolic flow, and feeding arteries and veins may be seen on Doppler imaging

hemangiomas

Occasionally, they contain punctate echodensities, representing phleboliths.

hemangiomas

sonography, both types of ____ appear as homogeneous or heterogeneous, predominantly hypoechoic masses with well-defined borders

hemangiomas

Congenital vascular lesions are of two types:

hemangiomas and vascular malformations.

The echogenicity ranges from hypo- to hyperechoic. Cystic changes due to _____ or necrosis and comet-tail artifacts (small echogenic foci with posterior reverberation artifacts) produced by ____ _____ can be seen

hemorrhage; inspissated colloid

Internal debris, fluid-fluid level, and thick walls can be seen if the cystic contents are ____, _____, ___ ______

hemorrhagic, proteinaceous, or purulent

Sonographic features of the ____ ____ ___ are an echogenicity similar to that of the normal mediastinal thymus and anatomic continuity with the mediastinal thymus

herniated mediastinal thymus

In younger children, the cricoid cartilage has a ___ ___ texture relative to the adjacent thyroid gland.

homogenous hypoechoic

Each anterior triangle is divided into suprahyoid and infrahyoid divisions by the ____ _____.

hyoid bone

The fat in lipoblastoma appears ____

hyperechoic

The sonographic appearance of a lipoma is that of a _____ mass.

hyperechoic

Clinical findings include polydipsia, polyuria, fatigue, and bone pain. Serum calcium levels are elevated. Treatment is surgical resection of any associated mass.

hyperparathyroidism

Indications for parathyroid imaging include evaluation of______ for detection of underlying causative lesions, guidance of fine-needle aspiration biopsy, and postoperative evaluation of persistent or recurrent hyperparathyroidism.

hyperparathyroidism;

Less frequently, _____ is a result of acute or subacute thyroiditis, hereditary autosomal dominant hyperthyroidism, toxic nodules, exposure to excessive amounts of iodine, and pituitary adenomas.

hyperthyroidism

Thyroid hemiagenesis: Compensatory _____ of the contralateral thyroid lobe is common due to thyroid tissue overstimulation by TSH. There is an increased risk of goiter as well as hypothyroidism.

hypertrophy

Hemangiomas are _____ on color Doppler imaging.

hypervascular

During inspiration, venous flow is _____ as a result of negative intrathoracic pressure, leading to a _____ diameter of the jugular vein and a ____ amplitude spectral waveform

increased; decreased; higher

Hemangiomas: The overall echogenicity ___ as the channels become smaller and undergo thrombosis during involution.

increases

During expiration and the Valsalva maneuver, intrathoracic pressure ____, causing ____ blood return and _____ diameter of the jugular vein. little or no flow is seen at these times. The walls of the vein collapse when moderate transducer pressure is applied.

increases; decreased; increased

An ____ _____ _____ line is the most common cause of jugular vein thrombosis.

indwelling central venous

There are two major types of Hemangioma:

infantile (common) and congenital (rare)

The ____ ____ _____ arise from the third branchial pouch and are located posterior or inferior to the lower pole of the thyroid gland

inferior parathyroid glands

infiltration: The margins of smaller lesions may be well-circumscribed, but ___ into adjacent soft tissues is common with larger lesions.

infiltration

multiple, enlarged, hypoechoic nodes, with normal central echogenic areas Transverse color Doppler image shows central vascularity.

inflammatory lymphadenitis.

The ___ ____ of the anterior cervical triangle contains the cervical part of the trachea, esophagus, thyroid and parathyroid glands, vagus nerve, and the ____ ____ and internal jugular vein.

infrahyoid portion; carotid artery

They may contain ___ ___, which appears as punctate echogenic foci.

inspissated colloid

The ___ ____ ____ supplies the brain, which has a low resistance to arterial inflow, resulting in waveforms that have a sharp rise during systole, a broad systolic peak, and continuous forward flow during diastole

internal carotid artery

Cholesterol crystals are another cause of ___ ____ and increased echogenicity.

internal debris

Clinical presentations of ____ _____ _____ _____ include cervical swelling or a palpable mass and poor venous return.

internal jugular vein thrombosis

Asymmetry in the size of the____ ____ _____ is a common normal variant. It is not unusual for the right internal jugular vein to be larger than the left, presumably because of the predominance of the right cerebral venous drainage

internal jugular veins

The ____ ___ _____ are responsible for return of venous blood from the brain to the heart.

internal jugular veins

Sjögren syndrome

is a chronic autoimmune disease characterized by lymphocytic and plasma cell infiltration, glandular destruction, and ductal dilatation.

Other predisposing conditions include neck surgery, intravenous drug abuse, head and neck neoplasms, mediastinal tumor, and inflammatory conditions such as cervical lymphadenitis, abscess or cellulitis, and bacterial pharyngitis

jugular vein thrombosis.

The nodes of the latter group are the largest in the upper neck, and the ____ node is the largest node in this chain.

jugulodigastric

Parathyroid Function: The target organs of PTH are the ____ ____ _____

kidneys and liver.

Occasionally, acute thrombus can be anechoic, mimicking flowing blood. The _________________________ flow on Doppler examination can establish the correct diagnosis.

lack of compressibility and absent

Anatomically, the gland is subdivided into a ___ ____ (lateral) and a smaller deep (medial) lobe

larger superficial

The nodes of the ___ ___ can be subdivided into superficial (external jugular) and deep (internal jugular, spinal accessory, and transverse cervical) groups

lateral neck

Second branchial cleft cysts are located in the ___ neck, usually inferior to the angle of the mandible, anterior to the sternocleidomastoid muscle,___ to the thyroid gland, and anterolateral to the carotid artery and jugular vein.

lateral; lateral

As compared to adults, thyroid nodules are far _____ ____ in children with an occurrence rate of 0.05% to 5.1% and are estimated to occur in 1% to 2% of the pediatric population

less common

Longitudinal and transverse scans are obtained with gray-scale, pulsed, and color flow Doppler imaging using ___ ____ ____on the neck to avoid collapsing the vein.

light transducer pressure

Ectopic thyroid tissue is most commonly seen (90%) in a ____ _____

lingual location (termed the lingual thyroid)

In infants, the myxoid components may predominate with only small amounts of fat.

lipoblastoma

The circumscribed _____ is more common (approximately 70% of cases) and is located in the superficial soft tissues.

lipoblastoma

The diffuse type of ____ (about 30% of cases) has an infiltrative growth pattern, involving the subcutaneous tissue and underlying muscle.

lipoblastomatosis

The imaging appearance reflects the amount of fat versus myxoid stroma.

lipomas

The natural history of lipoblastomas is to evolve into mature _____.

lipomas

Thyroid cancer: Most patients present with ___ disease. Distant metastases are found in only 8% and are usually in the lung and rarely in bone or liver.

local

Posterolateral to each thyroid lobe is the ___________________

longus colli muscle

The____ ____ ____ posterolateral to each lobe appears as a triangular-shaped hypoechoic structure on transverse scans and as a long, ____ ____ ____ ____ to the cervical vertebrae on longitudinal scans.

longus colli muscle; slender hypoechoic structure anterior

Pulsed Doppler analysis shows______ flow pattern, systolic Doppler shift greater than ____, and absence of ___ ____.

low-resistance; 2 kHz; arteriovenous shunting

Esophageal duplication or bronchogenic cysts occasionally can be found in the ___ ___.

lower neck

A coronal view through the supraclavicular fossa can be useful to assess the ___ ___ of the internal jugular vein and medial segment of the subclavian vein at the point where they join to form the ____ _____.

lower segment; brachiocephalic vein.

The ___ ___ in the upper neck, especially the internal jugular and spinal accessory nodes, are involved more frequently than those in the lower neck.

lymph nodes

On Doppler imaging, the fluid-filled spaces are avascular. Flow may be observed in the septa

lymphangioma

Similar to other cystic lesions, the echogenicity can increase secondary to hemorrhage, infection, and high lipid content, as well as following therapeutic injection

lymphangioma

_____ appears as a thin-walled, hypo- or anechoic, multilocular mass with septations of variable thickness

lymphangioma

About 75% of all _____ occur in the neck.

lymphangiomas

The remainder 25% are found in the axilla, mediastinum, retroperitoneum, bone, and abdominal viscera

lymphangiomas

The nodules are usually hypoechoic to normal thyroid tissue, but they may be isoechoic with a hypoechoic halo or complex.

lymphoma

Secondary hyperparathyroidism is due to ____ ____ in response to chronic ______, usually from chronic renal disease or intestinal malabsorption. Secondary hyperparathyroidism is treated ____.

multiglandular hyperplasia; hypercalcemia; medically

Multinodular goiter is defined as an enlarged thyroid gland (i.e., goiter) due to ____ ____ ______.

multiple hyperplastic nodules

Patients with ____ ____ may have few constitutional symptoms, and the nodes are often firm, nontender, and matted together.

mycobacterial infections

The sonographic findings include discretely enlarged nodes or a conglomerate nodal mass with hypoechoic echotexture, calcifications, and inflammatory changes in the cutaneous and subcutaneous tissues, Color Doppler sonography can show central, peripheral, or combined flow.

mycobacterial infections

The plunging or deep ranula extends beyond the sublingual space through the ___ ___.

mylohyoid muscle

___ ___ is the dividing line between the floor of the mouth and the neck.

mylohyoid muscle

Myofibromatosis: The terms ___ and _____ are used to refer to the solitary and multicentric forms of the disease process, respectively

myofibroma; myofibromatosis

Diagnosis is established primarily by demonstrating a markedly ____ _____ at color or power Doppler imaging. In total occlusion of the ICA, there is ____ _____ _____ _____ at gray-scale imaging and no flow with spectral, power, and color Doppler sonography.

narrowed lumen; no detectable patent lumen

The gray-scale finding of internal carotid artery (ICA) stenosis is vessel narrowing. Color Doppler findings of ICA stenosis are vessel _________ _____ _______ at the site of stenosis.

narrowing and aliasing

Cysts arising from the second branchial clefts are found lower in the ______

neck

At sonography, _____ appears as an elliptical or round, paraspinal mass. It may be isoechoic or hyperechoic to adjacent muscle and the echotexture may be homogeneous or heterogeneous. Scattered hyperechoic foci, representing calcifications, are common. Mild to moderate vascularity can be noted on Doppler imaging. Other findings include soft tissue infiltration, vascular encasement, and intraspinal extension. paraspinal location

neuroblastoma

A ___ ____ ____ usually is not seen on sonography.

nondilated Wharton duct

10 mm in short diameter. The hilum is echogenic on gray-scale images and shows central flow on Doppler imaging

normal supraclavicular nodes

Lymph nodes are ____ ____ ____ in the submandibular gland.

not normally seen

A cyst has no internal or external ____.

openings

The ectopic gland appears as an ___ _____ In neonates, it is _____ to adjacent tissues and vascular on Doppler sonography. In older children, it may appear _____ and hypovascular

oval mass; hyperechoic; hypoechoic

The sublingual gland is ___ ___ on transverse images and lentiform or ____ on longitudinal sections and lies parallel to the mandibular body

oval shaped; rectangular

parathyroid glands: However, they may be seen as separate ___ structures between the longus colli muscle and the thyroid gland when their echogenicity is ____ than that of the thyroid parenchyma.

oval; less

Infected cervical nodes present as ______________

painful, tender masses.

Children with Hashimoto thyroiditis present with ____ ____ of the thyroid gland (goiter).

painless enlargement

Thyroid cancer: Patients are usually euthyroid and present with a ____ ____thyroid nodule, regional adenopathy, or a combination of findings.

palpable solitary;

Both ______________________ have been associated with activation of the RAS-RAF-MEK-ERK (mitogen-activated protein kinase) pathway

papillary and follicular tumors

Survival is better for patients with ____ ____ than with medullary carcinoma.

papillary carcinoma

The major risk factor for developing ____ ___ is radiation exposure to the thyroid, usually for treatment of lymphoma

papillary carcinoma

The common histology in order of decreasing frequency is ____ ____ cancer 60%, _____ variant papillary cancer 23%, and _____ thyroid cancer 7.6%

papillary thyroid; follicular; medullary

It tends to be homogeneously hypoechoic to the thyroid gland.

parathyroid adenoma

The _____ _____ appears as a well-marginated mass that is juxtathyroid and located immediately posterior or inferior to the thyroid gland and medial to the carotid artery

parathyroid adenoma

Patients are usually normocalcemic and present with a palpable neck mass. However, there may be signs of hyperparathyroidism if the cysts are functional.

parathyroid cysts

Most____ _____ are located in the _____ parathyroid glands, although they can occur anywhere from the angle of the mandible to the superior mediastinum.

parathyroid cysts; inferior;

The ____ ____ receive their blood supply predominantly from the inferior thyroid arteries, although the superior thyroid gland may be supplied by the superior thyroid artery.

parathyroid glands

There are normally two superior and two inferior ____ _____.

parathyroid glands

First branchial cleft cysts are located in the ____ gland, near the external auditory, or at the angle of the mandible.

parotid

Hemangiomas and lymphatic malformations are the most common vascular lesions in the ___ ____

parotid gland

The ___ ___ appears as an oval, homogeneous structure anterior to the mandible, and inferior to the masseter muscle

parotid gland

Sjögren syndrome

parotid gland heterogeneous parenchymal echogenicity and multiple cystic spaces. Doppler image shows hypervascularity.

The ____ ____, the largest of the salivary glands, is bounded anteriorly by the ramus of the mandible and masseter muscle and posteriorly by the mastoid process and sternocleidomastoid muscle.

parotid gland;

Ninety to ninety-five percent of salivary gland tumors in children arise in the ___ ____, with the remaining tumors arising in the ____ glands

parotid gland; submandibular

Most ____ ____ present within a few weeks or months of birth as a nontender mass at the angle of the mandible, occasionally with bluish discoloration of the overlying skin.

parotid hemangiomas

Sonographic features of chronic recurrent, idiopathic _____ are a normal sized or small, heterogeneous gland, multiple, small, round, or oval hypoechoic areas, representing sialectasis (ductal ectasia) or lymphocytic infiltration within the parenchyma, and punctate echogenic foci, representing calcifications or mucous within areas of sialectasis or the parenchyma of the gland itself

parotitis

Separating parathyroid from thyroid cysts may require ___ ____ of the cyst with assay of PTH; In parathyroid cysts, the PTH levels in the fluid are elevated when compared with serum PTHlevels

percutaneous aspiration

The feeding artery tends to course around the ____ of the gland before penetration, producing a ____ ____ or arc

periphery; vascular rim

The production of these hormones is mediated by thyroid stimulating hormone (TSH), which is secreted by the ___ ____.

pituitary gland

Benign epithelial neoplasms of the salivary glands are rare in childhood and these usually are _____ _____.

pleomorphic adenomas

It presents as a painless submandibular or submental neck mass with or without an associated mass in the floor of the mouth.

plunging or deep ranula

In the lower neck at the level of the thyroid gland, the carotid sheath structures lie _____ _____ ______ to the thyroid gland and sternocleidomastoid muscle

posterior and lateral

The ___ ___ contains lymph nodes, the spinal accessory nerve, parts of the subclavian artery and vein, and portions of the brachial plexus and phrenic nerve.

posterior triangle

malignant tumors: ____ ____ tend to be poorly circumscribed with irregular or lobulated margins and heterogeneous, hypoechoic echotexture. However, malignant lesions also can be homogeneous with well-defined borders.

primary carcinomas

Acquired causes include ____ ____, such as autoimmune thyroiditis, Hashimoto thyroiditis, and subacute thyroiditis, and secondary causes, such as an abnormality in the pituitary gland or hypothalamus resulting in decreased or absent production of TSH or TRH, end organ unresponsiveness to thyrotropin or thyroid hormone, and radiation therapy

primary disorders

Nodal metastases have echotexture similar to that of the _____ ____. They may contain calcification, necrosis, or hemorrhage. The central hilar echogenicity is typically _____

primary tumor; absent.

Other indications include screening of patients with histories of head and neck ____, guidance of fine-needle aspiration biopsy of a _____, follow-up evaluation of changes in the size of a nodule or the thyroid gland itself in patients receiving replacement or ____ _____, and detection of recurrence in patients who have had prior surgery for treatment of thyroid ____

radiation; nodule; suppressive therapy; cancer

Beneath the left mandibular ramus shows a thin-walled, cystic mass in the floor of the mouth close to the mandible

ranula

Causes of obstruction include post-inflammatory stricture, trauma, or calculus.

ranula

____ is a mucus retention cyst that arises from an obstructed sublingual or minor salivary duct in the floor of the oral cavity.

ranula

the location of this lesion in the floor of the mouth is a clue to the diagnosis.

ranula

Most ____ demonstrate homogeneous, hypoechoic, or anechoic contents.

ranulas

On sonography, simple ___ appear as well-defined, thin-walled lesions above the mylohyoid muscle in the floor of the mouth.

ranulas

Congenital hemangiomas: Based upon their natural history, two major subtypes have been recognized:

rapidly involuting congenital hemangiomas (RICH) and non-involuting congenital hemangiomas (NICH)

Squamous cell carcinoma is a ____ head and neck tumor in children.

rare

Third and fourth branchial cleft cysts are ____.

rare

malignant tumors : Mucoepidermoid carcinoma, adenocarcinoma, and squamous cell carcinoma have the highest incidence of ___ ___ ___.

regional nodal spread

The ___ ___ is used as the sonographic landmark to separate the superficial and deep lobes

retromandibular vein

The ____ ____ lies anterior to the external carotid artery

retromandibular vein

Other findings include parenchymal calcification, soft tissue infiltration, vessel encasement, and regional lymph node enlargement. Mild to moderate hypervascularity may be noted on Doppler interrogation.

rhabdomyosarcoma

The sonographic appearance of ____ is similar to that of neuroblastoma.

rhabdomyosarcoma

The tumor is usually hypoechoic or isoechoic to normal muscle and the architecture may be homogeneous or heterogeneous.

rhabdomyosarcoma

Rhabdomyosarcoma, undifferentiated cancer, adenocarcinoma, malignant mixed tumor, adenoid cystic cancer, squamous cell cancer, embryoma, and sialoblastoma are less common __________________

salivary gland tumors in children

The external carotid artery supplies the high-resistance vascular bed of the _______________ and, thus, the waveform has a high-resistance pattern, resulting in a ____ rise during systole, narrower systolic peaks, and lower levels of flow during diastole

scalp and facial muscles; sharp

Hyperplastic nodules: Cystic changes are common. Large cysts may have internal ____, thick walls, and solid mural nodules. Doppler sonography shows varying amounts of ____ and peripheral flow.

septations; internal

Factors that portend a worse outcome for thyrpid cancer are male ___, nonpapillary histology, distant ____, and no ____.

sex; metastases; surgery

The close association with the carotid sheath or mediastinal extension should suggest the diagnosis of ____ ____.

thymic cyst

The ___ ____ (sternohyoid, sternothyroid, thyrohyoid, and omohyoid muscles) of the neck are located anterior and lateral to the thyroid gland and appear ____ compared to the thyroid gland.

strap muscles; hypoechoic

Constant landmarks seen on all sonograms of the neck are the ___ ___, anterior wall of the ___, the carotid sheath, and the thyroid gland

strap muscles; trachea

The ____ ____, the smallest of the salivary glands, are imaged with the transducer perpendicular and parallel to the submental mandible

sublingual glands

The glands lie below the floor of the mouth between the mandible and muscles of the floor of the oral cavity, and anterior to the submandibular glands

sublingual glands

The lateral border of the glands is adjacent to the mandible. The excretory duct courses along the medial part of the gland

sublingual glands

ranula: The more common simple type is restricted to the ____ space, usually presenting as a painless, bluish, intraoral mass beneath the tongue.

sublingual;

80% to 90% of salivary gland calculi occur in the ____ duct, with the remainder occurring in the parotid duct

submandibular

The ____ _____ is evaluated by placing the transducer under the body of the mandible anterior to the mandibular condyle.

submandibular gland

The ___ ___ contains lymph nodes and the submandibular gland.

submandibular triangle

It contains small lymph nodes and branches of the facial artery and vein

submental triangle

The suprahyoid division is further subdivided into ___ and ____ triangles by the digastric muscle.

submental;submandibular

Infected cysts may be ___ and painful.

tender

A ____ is a congenital lesion arising from pluripotential germ cells

teratoma

It typically contains tissue from all three embryonic germ layers (ectoderm, mesoderm, and endoderm).

teratoma

At sonography, they appear as complex masses with cystic components representing sebum or fluid and echogenic foci representing fat, calcification, or soft tissue. Relatively avascular on Doppler imaging; upper anterior neck location and complex echogenicity

teratomas

Most _____ arise in the anterior suprahyoid neck. They may be midline or off midline in location and adjacent to or within a thyroid lobe

teratomas

the carotid artery normally has a _____ wall than the jugular vein

thicker

The ___ ___ is a well-marginated, unilocular, or multilocular hypoechoic mass

thymic cyst

Typically, the carotid artery wall appears as ________ ____ _____ _____ with a hypoechoic layer in between. Color flow Doppler imaging is useful to demonstrate the presence and direction of flow and to detect thrombus and stenosis.

two thin bright lines

Parathyroid adenomas are ____ hypoechoic, show ____ ___, and are posterior or lateral to the thyroid gland

uniformly; peripheral flow

These conditions drain predominantly to the submandibular and deep cervical (jugular chain) nodes.

upper respiratory tract infections, tonsillar and pharyngeal infections, and recent dental work

Congenital lesions Neck masses

vascular lesions, thyroglossal duct cysts, branchial cleft cysts, teratomas, dermoids, and thymic cysts

Benign neoplasms account for 65% to 70% of salivary gland neoplasms and are usually ____ ____ or ___ ____ ____

vascular lesions; branchial cleft cysts

Infantile hemangiomas are congenital ___ ___ composed of thin-walled, endothelial-lined vascular channels.

vascular masses

Pulsed Doppler sonography shows ____ _____ related to cardiac contractions and intrathoracic pressure changes

venous pulsations

The common indications for sonography of the internal jugular vein are evaluation of suspected ___ ____ and assessment of vessel ____ prior to insertion of a central line.

venous thrombosis; patency

Infected cysts can show flow in the ___ of the cyst or in ___ ___ ___ if there is associated cellulitis

wall; surrounding soft tissues

The Stensen duct lies along the anterior border of the parotid gland below the ___ ____

zygomatic arch