CHAPTER 12 - THE FACE AND NECK

10 mm / 1 cm

A thyroid isthmus that measures greater than what is indicative of thyroid enlargement?

Depression increased cold sensitivity elevated blood cholesterol levels slight weight gain may occur puffy face and eyes

Clinical findings of Hashimoto

Sialolithiasis

Stones in the salivary duct;

Colloid

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

Mucoepidermoid carcinoma

The most common form of salivary gland cancer?

Sound off

Goiter is the general term for thyroid enlargement that can result from inadequate iodine intake.

Thyroid measurements

4-6 cm in lengt, 2-3 cm in width, 1-2 cm in thickness. isthmus: 2-6 mm

Lymphadenopathy

A 45 year old female presents to the sonography department with a palpable neck mass 6 months following a thyroidectomy for papillary carcinoma. Which of the following would be the most likely etiology of the palpable mass?

Branchial cleft cyst

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

Sjogren's syndrome

An autoimmune disease that affects all glands that produce moisture; leads to dysfunction of the salivary glands and severe dryness of the eyes, nose, skin and mouth. Heterogeneous, hyperemic, visibly enlarged and may contain diffuse hypoechoic regions

strap muscles

Anterior to each lobe

Pleomorphic adenoma

Benign and most frequent tumor of the salivary glands; most commonly seen in the parotid gland. Hypoechoic mass, biopsy is often warrented.

Extensive cystic components Cysts < 5 mm Hyperechoic mass Eggshell calcifications Hot nodule

Benign characteristics of thyroid nodule

Thyroglossal duct cyst

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

Branchial cleft cysts

Benign congenital neck cysts found most often near the angle of the mandible

A hypoechoic, oblong structure with a distinct echogenic hilum

Best describes the normal appearance of a cervical lymph node;

Bulging eyes Heat intolerance NErvousness Weight / hair loss

Clinical findings of Graves Disease

Anechoic nodule Eggshell calcification Hyperechoic nodule

Diagnostic findings of a likely benign thyroid nodule;

Sialadenitis

Inflammation of the salivary glands. Heterogenous, hyperemic, visibly enlarged and may contain diffuse hypoechoic regions.

CCA and IJV

Lateral to each lobe

Sternocleidomastoid muscles

Lateral to each lobe

Mucoepidermoid carcinoma

Most common malignancy of the salivary glands; typically starts in the parotid gland. Hypoechoic or heterogeneous mass with moderate to marked internal vascularity, biopsy is often warranted.

Esophagus

Most often seen on the left side posterior to the trachea and thyroid;

4

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

Calcium

Parathyroid glands control the release and absorption of which nutrient?

Longus colli muscles

Posterior to each lobe

Punctate calcific deposits

Psammoma bodies are;

Thyroglossal duct

The embryonic duct that is located from the base of the tongue to the midportion of the anterior neck

multinodular goiter or adenomous goiter.

The enlarged thyroid gland that contains multiple nodules with cystic and solid components maybe referred to as a;

Hot nodules

The hyperfunctioning thyroid nodules seen on a nuclear medicine study that are almost always benign

Cold nodules

The hypofunctioning thyroid nodules seen on a nuclear medicine study that have a malignant potential

Stensen's duct

The main duct of the parotid gland

Pyramidal lobe

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

Wharton duct

What duct drains the submandibular gland?

Thyroxine

What hormone is the most abundantly produced by the thyroid?

Fibromatosis colli

What is associated with congenital muscular torticollis?

Superior thyroid artery

What is the first branch of the external carotid artery?

Endocrine

What type of gland is thyroid gland?

Grave's disease

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

Parotid gland

Which gland is located immediately anterior to the ear?

Sternocleidomastoid

Which muscle does fibromatosis colli mostly affect?

Strap

Which muscles are located anterior to the thyroid gland?

Sternocleidomastoid

Which muscles are located lateral to each thyroid lobe?

Longus Colli

Which muscles are located posterior to each thyroid lobe?

Parathyroid adenoma

With what elevated serum calcium associated?

Cold nodule

Would more likely be a malignant thyroid nodule?

Grave's disease

bulging eyes, hair and weight loss, heat sensitivity, hyperthyroidism, nervousness. thyroid inferno, enlarged gland, heterogenous or diffusely hypoechoic echotexture.

Hashimotos

chronic autoimmune lymphocytic thyroiditis.

common carotid artery

lateral to each lobe

esophagus

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

Thyroglossal duct cyst

palpable mass within them midline of the neck superior to the thyroid gland, infected cysts might be painful. anechoic, well defined, cyst with posterior enhancement, may have internal components. typically located below the hyoid bone.

longus colli muscles

posterior to each lobe

Fibromatosis Coli (congenital torticollis)

rare, pediatric fibrous tumor located within the sternocleidomastoid muscle. twisted neck with the chin angled to the non-affected side. fusiform shaped mass, hypoechoic, hyperechoic or isoechoic to the adjacent tissue. may contain calcifications that shadow. may have hyperemic pattern with color.

Psammoma bodies

round calcific deposits that appear as punctate, hyperechoic foci without acoustic shadowing.

Thyroglossal duct cyst

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

Thyroxine Triiodothyronine Calcitonin

Hormones that are produced by the thyroid;

Hypoechoic mass Taller than wide shape Mass with internal calcifications Solitary mass Marked vascularity within the central part of the nodule Interrupted peripheral calcification Extracapsular invasion Lobulated margins Enlargement of the cervical lymph nodes Cold nodule

Malignant characteristics of thyroid nodules;

Graves disease

Most common cause of hyperthyroidism;

Hashimoto's thyroiditis

Most common cause of hypothyroidism;

Papillary

Most common form of thyroid cancer;

Sialotithiasis

Salivary duct stones; most commonly located within the submandibular gland. Dilated duct containing a shadowing, echogenic focus/foci.

Wharton duct

The duct that drains the submandibular gland

IJV

superior and lateral to each CCA

Parathyroid adenoma

A pt with hypercalcemia presents to the sonography department for a neck sonogram. What abnormality in the neck should be suspected?

Strap muscles

Anterior to each lobe

Mild enlargement of the thyroid gland Heterogeneous echotexture Multiple, ill defined hypoechoic regions separated by fibrous hyperechoic tissue Hypervascular gland

Sonographic Findings of Hashimoto

Enlarged gland Heterogenous or diffusely hypoechoic echotexture Thyroid inferno (hypervascularity within the thyroid gland)

Sonographic findings of Graves Disease

Rounded shape Calcifications Enlargement

Sonographic findings of an abnormal lymph node;

Internal calcifications Cervical node involvement Solitary mass

Sonographic findings of malignant thyroid nodules;

10 mm / 1cm

A normal lymph node will not measure greater than;

sternocleidomastoid muscles

lateral to each lobe

internal jugular vein

lateral to each lobe, superior and lateral to each CCA