Parathyroid Glands

Hyperparathyroidism

Caused by excessive function and production of the parathyroidism. Results in reabsorption of calcium from the skeletal system.

Hyperparathryoidism Ultrasound Appearance

Homogenous nodule containing low-level echoes. Differentation of PT gland from thyroid nodule can be made by noting oblong shape and location behind the thyroid.

Parathyroid Carcinoma

Malignant functioning epithelial neoplasm that infiltrates surrounding tissue. Found in 1% of patients with primary hyperparathyroidism. Increased serum calcium and PTH.

Functions of PTH in the body

Stimulate breakdown of bone to release calcium into the blood. Enhance Reabsorption of calcium by the kidneys. Increase calcium absorption by intestine.

Chief cells

The Parathyroid contains ___________ which secretes PTH.

Cervical Lymphadenopathy

When __________ is noted, check for hepatomegaly, ascites, hydronephrosis, and splenomegaly.

Primary Hyperthyroidism

________ is associated with parathyroid adenoma, hyperplasia, and carcinoma.

Secondary Hyperthyroidism

________ is associated with patients with renal failure on long-term dialysis.

Vitamin D

________ is required for absorption of calcium by the intestine.

Salivary Glands

Pathology of the _______ includes enlargment, cysts, benign tumors, and malignant tumors. All are fairly rare.

Parotid, submandibular, and sublingual.

Three major glands that secrete saliva.

Normal Parathyroid Size

5x3x1mm

Hyperparathyroidism

Alkaline phosphatase is increased in __________.

Branchial Cleft Cyst

Also known as a lateral cervical cyst. Cystic diverticulum may extend laterally from the pharynx or medially from the neck. Palpable mass in LATERAL neck. Does not move with swallowing.

Branchial Cleft Cyst Ultrasound Appearance

Anechoic mass with smooth, thin walls and posterior acoustic enhancement. Usually lateral to the thyroid gland.

Parathyroid Cyst Ultrasound Appearance

Anechoic with sharply defined walls and borders. Vary in size and generally single.

Abscess

Can arise at any location in the neck. Ranges from fluid filled to completely echogenic.

Ultrasound Appearance of Parathyroid Carcinoma

Carcinoma is usually larger than adenoma. Round or ovoid shape with heterogeneous echotexture.

Cervical Lymphadenopathy Ultrasound Appearance

Enlarged nodular lesions of variable size. Hypoechoic with low-medium level echogenicity. Homogeneous and well circumscribe. The more rounded, the more likely it is malignant.

Cervical Lymphadenopathy

Enlargement of the lymph nodes or vessels. Result of metastatic head or neck carcinomas, inflammation, TB, or lymphoma. Normal nodes are max 5mm.

Parathyroid Ultrasound Appearance

Flat, disk shaped, oval, or almond shaped. Homogenous and isoechoic to thyroid. Rarely seen unless enlarged.

Parathyroid Gland

Located on the posterior medial surface of the thyroid gland. Most people have 4. Yellow/Red in Color. Not often seen on US.

Thyroglossal Duct Cyst

Most common congenital cyst found in the neck. Is a remnant of thyroid gland migration. Palpable MIDLINE neck mass. Moves upward when tongue is extended.

Parathyroid Adenoma Ultrasound Appearance

Oval discrete lesion less than 5mm. Hypoechoic compared to thyroid tissue. Homogeneously solid.

Increased

PTH is ________ in hyperparathyroidism due to solitary adenoma, secondary hypoplasia, and Vitamin D deficiency

Decreased

PTH is ________ in hypoparathyroidism, accident removal of parathyroid, autoimmune destruction of parathyroid glands, and metastatic bone tumors.

Increased

Serum Calcium is ______ in hyperparathyroidism, malignant tumors, hyperthyroidism, excessive calcium intake, and parathyroid adenoma.

Decreased

Serum Calcium is ______ in therapeutic hemapheresis, massive blood transfusion, vitamin D deficiencies, hyperparathyroidism, and acute pancreatitis.

Parathyroid Adenoma

Solid, benign epithelial tumor of the parathyroid gland causing excess secretion of PTH. Cause of primary hyperparathyroidism.

Parotid Gland

The largest salivary gland is the _________. It is composed of tubuloacinar glands.

Hypercalcemia

The most common referral for parathyroid sonography are patients with unexplained __________.

Calcium

The parathyroid glands regulate the metabolism of ________ and secrete hormone accordingly.

Submandibular Gland

The second largest salivary gland is the ________. It is composed of acinar glands.

Sublingual Gland

The smallest salivary gland is the _______. It is composed of acinar glands.

Parathyroid Cyst

Uncommon solitary lesions in the lower neck. Contains clear serous fluid with a high level of PTH. Dense and fibrous walls.