Thyroid & Neck
Which transducer should the sonographer use to obtain the widest field of view of and the best resolution to detect small lesions?
7.5 - 15 MHZ, Linear Array
A 53-year old woman presents with the most common solid mass sonographically identified as well circumscribed, an oval contour and a halo effect?
Adenoma
They thyroid gland is connected in the middle by the
Isthmus
Structure located posterior to the bilateral lobes of the thyroid gland?
Longus Colli Muscle
The thyroid gland is
An endocrine gland
Name likely benign thyroid nodule.
Anechoic nodule, eggshell calcification, hyperechoic nodule
The thyroid gland is located on the ______________ Side of the trachea
Anterior
Normal parathyroid glands
Are occasionally identified in young children
Most common cause of hypothyroidism?
Hashimoto's thyroiditis
A 45 year old female patient presents to the sonography department with a palpable neck mass 6 months following a thyroidectomy for papillary carcinoma. What would be most likely etiology of the palpable mass?
Lymphadenopathy
What is an auto immune disease that affects the glands that produce moisture, leading to dysfunction of the salivary glands, and dryness of the eyes, nose, skin, and mouth?
Sjogren syndrome
What is the first branch of the external carotid artery?
Superior thyroid artery
Benign congenital cysts located superior to the thyroid gland near the hyoid bone are referred to as:
Thyroglobulin duct cysts
What is the hormone that is the most abundantly produced by the thyroid?
Thyroxine
Hormones produced by the thyroid:
Thyroxine, triiodothyronine, calcitonin
Esophagus
Tube connecting the mouth to the stomach
What does the thyroid gland utilize to produce its hormones
Iodine
Which muscles are located posterior to each thyroid lobe?
Longs colli
Which gland is located immediately anterior to the ear?
Parotid gland
The long sections of the lobes appear sandwiched between the _______________anteriorly and _____________posteriorly
Strap muscles, longus colli muscles
You have been requested to perform a thyroid ultrasound on a patient with a palpable nodule in the left neck. What transducer would provide the most optimal scan?
10.0 MHz linear array
A normal lymph node will not measure greater than:
10mm
What best describes the normal appearance of a cervical lymph node?
A hypoechoic, oblong structure with a distinct echogenic hilum
You are performing a thyroid ultrasound on a patient with a history of Hashimoto's thyroiditis. What is the sonographic appearance of this condition?
Diffuse enlargement of the thyroid with heterogeneous echotexture
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 common cause of hyperthyroidism?
Graves disease
The best way to image the inferior portion of the thyroid lobes is to
Have the patient swallow
What can be excluded when the patient presents with a normal thyroid stimulating hormone(TSH) level?
Hypothyroidism
Most common form of thyroid cancer?
Papillary
What is the term for stones within the salivary duct?
Sialolithiasis
Which muscles are located anterior to the thyroid gland?
Strap
True regarding thyroid nodules:
The overwhelming majority of thyroid nodules are benign, thyroid nodules are very common, nodules with a significant cystic component are usually benign, nodules may be hyperechoic or hypoechoic to the thyroid
In the presence of hashimoto thyroiditis, the thyroid produces:
Too few thyroid hormones
During sonographic imaging of the thyroid, you detect several cervical lymph nodes, possibilities are
Visualization of inflammatory lymph nodes in the neck is common, most normal cervical lymph nodes have an oblong or oval shape, the greatest dimension in normal cervical lymph nodes is the longitudinal axis, most inflammatory lymph nodes exhibit an echogenic hilum
What do thyroid hormones regulate?
metabolic rate
isthmus of thyroid gland
middle of thyroid gland that covers some of the ventral portion of the trachea
A patient with hypercalcemia presents to the sonography department for a neck sonogram. What abnormality in the neck should be suspected?
parathyroid adenoma
Which of the following would more likely be a malignant thyroid nodule cold nodule or hot nodule?
Cold nodule
The fluid produced by the thyroid gland that contains thyroid hormones is referred to as:
Colloid
During transverse intonation of the thyroid gland, you detect two large vessels just lateral to the thyroid. What is the most medial vessel?
Common carotid artery
The lobes of the thyroid gland are bordered laterally by the _________________ & ___________________________
Common carotid artery, internal jugular vein
What is associated with congenital muscular torticollis?
Fibromatosis colli
A patient has been referred for a thyroid ultrasound to locate parathyroid adenoma. How many parathyroid glands are present in most people?
Four
You are performing an ultrasound exam on a patient with parathyroid hyperplasia. How many glands are usually involved in this condition?
Four
Which abnormality is associated with the sonographic findings of a thyroid inferno?
Graves disease
You are performing a thyroid study on a patient with an enlarged gland. Color Doppler shows markedly increased vascularity of both lobes. What is most likely?
Graves' disease
You are performing a thyroid ultrasound on a young woman with hypothyroidism. You detect a moderately enlarged, hypoechoic thyroid with a coarsened parenchymal echotexture. What condition is most likely present, considering the history and findings?
Hashimoto's thyroiditis
During transverse imaging of the thyroid, you detect a hypoechoic, round nodule posterior and medial to the thyroid. How can you determine if this is the esophagus or a nodule?
Have the patient swallow while scanning the area
You have been asked to identify a parathyroid adenoma. What is typical sonographic appearance of this structure?
Homogeneous, hypoechoic, solid oval-shaped nodule
Where is the thyroid gland located?
In the lower neck, anterior to the trachea
The thyroid gland is located
In the lower, anterior portion of the neck, anterior to the trachea and inferior to the larynx
Psammona bodies are
Punctuate calcific depositsq
The superior extension of the thyroid isthmus is referred to as the:
Pyramidal lobe
You have identified the thyrocervical truck in a patient with hyper vascular thyroid nodule. The thyrocervial trunk arises from what artery?
Subclavian artery
The superior thyroid artery is a branch of what artery?
external carotid
Grave's Disease is most common cause of
hyperthyroidism
Sternocleidomastoid muscle
one of two muscles arising from the sternum and the inner part of the clavicle and inserting at the mastoid process and rotating and laterally flexing the neck
Bilaterally, which structure is positioned adjacent to the trachea?
thyroid gland
The long sections of the lobes appear sandwiched between the ______________________anteriorly and __________________posteriroly
Strap muscles, longus colli muscles
A cold nodule indicates the thyroid was unable to complete what function with the radiopharmaceutical?
absorb
What type of gland is the thyroid gland?
endocrine
The normal thyroid gland generally appears as
uniform echoes, isotonic to liver parenchyma
What vessel is seen to course through the transverse foramina of the cervical spine?
vertebral
A cystic mass noted at the mandibular angle is most likely a:
Bronchial cleft cyst
Condition suggestive of parathyroid pathology?
Hypercalcemia
What is the most common form of salivary gland cancer?
Mucoepidermoid carcinoma
What is the role of color and spectral Doppler in evaluating thyroid nodules?
Neither color nor spectral Doppler have been shown to be sensitive in determining if a thyroid nodule is benign or malignant
You are performing a thyroid sonogram on a patient with a nodule suspicious for malignancy. What is the most common form of thyroid cancer?
Papillary carcinoma
Pathology responsible for the majority of primary hyperparathyroidism cases?
Parathyroid adenoma
With which of the following is elevated serum calcium associated?
Parathyroid adenoma
While performing a thyroid ultrasound, you detect a lymph nod suspicious for malignancy. What sonographic features are consistent with nodal malignancy in the neck?
Rounded lymph node, heterogenous echotexture, intranodal calcification, absence of an echogenic hilum
Name abnormal lymph node findings.
Rounded shape, calcifications, enlargement
The best patient position to scan the thyroid gland is
Supine, neck mildly hyperextended
The best approach when scanning the thyroid gland is
To use a light touch
What developmental cyst occurs because of a congenital modification in the cervical lymphatic system?
cystic hygroma
Parathyroid glands control the release and absorption of which nutrient?
Calcium
Which vascular structure is located closest to the thyroid lobes?
Common carotid artery
The main function of thyroid hormones is to
Increase metabolism
The size of the thyroid gland is
Influenced by body habitus
Name Malignant thyroid nodule.
Internal calcifications, cervical node involvement, solitary mass
In the above question, what is the most lateral vessel?
Internal jugular vein
You are performing an ultrasound exam to rule out the presence of parathyroid adenoma. Hyperparathyroidism is usually caused by enlargement of how many parathyroid glands?
One
The parathyroid glands lie between the _____________aspect of the thyroid gland and the ____________________________
Posterior, longus colli muscle
Which muscle does fibromatosis colli mostly affect?
Sternocleidomastoid
Which muscles are located lateral to each thyroid muscle?
Sternocleidomastoid
Muscle seen as thin, hypoechoic bands immediately anterior to each thyroid lobe?
Sternohyoid and sternothyroid
internal jugular vein
Vein located at the side of the neck to collect blood from the brain and parts of the face and neck.
Each lobe is oriented vertically in the neck, therefore, the long axes are visible in Sagittarius scanning planes
Vertically, Sagittal
Trachea
a large membranous tube reinforced by rings of cartilage, extending from the larynx to the bronchial tubes and conveying air to and from the lungs; the windpipe.
On the left side of the neck, common carotid arises from what artery?
aortic arch
You are performing a a thyroid ultrasound on a patient with increased serum calcium levels. What pathology are you searching for?
parathyroid adenoma
A thyroid isthmus that measures greater than __________is indicative of thyroid enlargement.
10mm
Normally, how many parathyroid glands are found within the adult neck?
4
The average normal adult thyroid gland is approx ______________cm long, __________cm anteroposteriorly and _______cm at it's greatest width.
4 to 6, 1.3 to 1.8, 3
Most common inflammatory disease of the thyroid?
Hashimoto's thyroiditis
The long axis of the isthmus is situated ______________and viewed from a _____________scanning plane at the midline of the neck
Horizontally, transverse
What muscle is located posterior to each lobe of the thyroid?
longus coli
The longus colli muscle is located
posterior to each thyroid lobe
The thyroid gland has two lateral_____________connected by the __________________
Lobes, isthmus
Because an adenoma of the thyroid gland has sonographic appearances ranging from anechoic to hyperechoic, what observation is helpful to distinguish an anechoic adenoma from a simple cyst?
Lack of discrete margins in the adenoma
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 not that the patient has bulging eyes. What is most likely diagnosis?
Graves disease
The long axis of the isthmus is situated_____________and viewed from a _____________scanning plane at the midline of the neck
Horizontally, transverse
The thyroid gland is __________________ relative to the strap muscles
Hyperechoic
Correct patient positioning for sonographic evaluation of the thyroid?
Patient in supine with neck hyperextended by a pad underneath the scapulae
Sonographic features include an irregular, solid, uneven, neovascular, hyperechoic mass with internal echoes?
Thyroid carcinoma
A patient presents with a cold thyroid nodule on a technetium-99m radioiodine scintigraphy exam?
Thyroid cyst
Which is the duct that drains the submandibular gland?
Wharton duct