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