Chapter 12: The Neck
What is the first branch of the external carotid artery?
superior thyroid artery
What is the most abundant hormone released by the thyroid?
thyroxine
A normal lymph node will not measure greater than:
10mm
result from infections and malignancy
abnormal lymph nodes
what are the sonographic findings of a branchial cleft cyst?
anechoic mass with posterior enhancement
what are the sonographic findings of a thyroglossal duct cyst?
anechoic, well defined, and unilocular cyst with posterior enhancement
an enlarged, hyperplastic thyroid gland
goiter
muscles posterior to each lobe
longus colli muscles
causes of a goiter
many causes, including iodine deficiency, Graves disease, and thyroiditis
most common cause of enlargement of parathyroid gland
parathyroid adenoma
What are the sonographic findings of an abnormal lymph node?
rounded shape, calcifications, enlargement
what is the sonographic appearance of parathyroid glands?
similar to thyroid tissue
as the disease progresses patients with Hashimoto's may present with?
slight weight gain, depression, increased cold sensitivity, and elevated blood cholesterol levels
A thyroid isthmus that measures greater than ___________ is indicative of thyroid enlargement.
10 mm
What is the normal measurement for the isthmus?
2-6 mm in AP diameter
Normally, how many parathyroid glands are found within the adult neck?
4
What are normal measurements for the thyroid?
4-6 cm L, 2-3 cm W, 1-2 cm thick
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 note that the patient has bulging eyes. What is the most likely diagnosis?
Graves disease
What is the most common cause of hyperthyroidism?
Graves disease
Which abnormality is associated with the sonographic findings of a thyroid inferno?
Graves disease
may be referred to as diffuse toxic goiter
Graves disease
most common cause of hyperthyroidism
Graves disease
thyroid may appear diffusely heterogeneous or hypoechoic, hypervascularity may be noted with color Doppler (termed thyroid inferno)
Graves disease
What is the most common cause of hypothyroidism?
Hashimoto thyroiditis
an autoimmune disease that is the most common cause of hypothyroidism in the United States
Hashimoto thyroiditis
patients are asymptomatic in early stages of the disease
Hashimoto thyroiditis
What are indications for a thyroid sonogram?
a palpable mass, abnormal lab findings, f/u exam from nuclear medicine and other diagnostic exam studies
most common masses identified within the thyroid gland with sonography
benign thyroid nodules
A cystic mass noted at the mandibular angle is most likely a:
branchial cleft cyst
congenital neck cysts located near the angle of the mandible
branchial cleft cysts
clinical findings in individuals suffering from hyperthyroidism include
bulging eyes, heat intolerance, nervousness, weight loss and hair loss
Parathyroid glands control the release and absorption of which nutrient?
calcium
enlargement of cervical lymph nodes
cervical lymphadenopathy
what can Hashimoto thyroiditis also be referred to as?
chronic autoimmune lymphcytic thyroiditis
What are the two prominent vascular structures seen lateral to the thyroid gland?
common carotid artery and internal jugular vein
what lab values are elevated with parathyroid adenoma?
elevated serum calcium and PTH (parathyroid hormone)
what are the sonographic findings of abnormal lymph nodes?
enlargement of the node > 1 cm, rounded shape, loss of the echogenic hilum, calcifications
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 often seen on the left side posterior to the trachea and thyroid
esophagus
what are characteristics of benign thyroid nodules?
extensive cystic components, cysts <5mm, hyperechoic mass, "eggshell" calcifications, "hot" nodule (NM)
most common benign thyroid neoplasm
follicular adenomas
What can benign thyroid nodules be considered?
follicular adenomas or hyperplastic nodules
What transducer is used for a thyroid sonogram?
high-frequency linear
referred to as adenomatous nodules, are almost always multiple and have varying sonographic appearances
hyperplastic nodules
A surplus of thyroid hormones is called?
hyperthyroidism
condition that results from the overproduction of thyroid hormones
hyperthyroidism
What describes the normal appearance of a cervical lymph node?
hypoechoic, oblong structure with a distinct echogenic hilum
condition that results from the underproduction of thyroid hormones
hypothroidism
A reduction of thyroid hormones is called?
hypothyroidism
What are the sonographic findings of malignant thyroid nodules?
internal calcifications, cervical node involvement, solitary mass
Which vascular structure is located closest to the thryoid lobes?
internal carotid artery
The thyroid gland utilitzes what to produces its hormones?
iron
a bridge of tissue crosses over the midline of the neck anterior to the trachea, providing a link between the two lobes
isthmus
The thyroid consists of what lobes?
left and right
Which muscles are located posterior to each thyroid lobe?
longus colli
the presence of _________________ increases the likelihood of a malignancy
microcalcifications
the enlarged thyroid gland that contains multiple nodules with cystic and solid components may be referred to as
multinodular goiter or adenomatous goiter
What is the most common form of thyroid cancer?
papillary
appears as a solid mass that will be hypoechoic to the adjacent thyroid gland
parathyroid adenoma
serve as calcium regulators for the body
parathyroid glands
The superior extension of the thyroid isthmus is referred to as the:
pyramidal lobe
a normal variant that is a superior extension of the isthmus
pyramidal lobe
Which muscles are located lateral to each thyroid lobe?
sternocleidomastoid
muscles anterior to each lobe
strap muscles (sternohyoid, sternothyroid, and omohyoid)
Benign congenital cysts located superior to the thyroid gland near the hyoid bone are referred to as?
thyroglossal duct cyst
benign congenital cysts located within the midline of the neck superior to the thyroid gland and near the hyoid bone
thyroglossal duct cysts
an isthmus that measures greater than 10mm is indicative of
thyroid enlargement - goiter
What is the hormone that is the most abundantly produced by the thyroid?
thyroxine
What hormones does the thyroid release?
thyroxine (T4), triiodothronine (T3), and calcitonin
In the presence of Hashimoto thyroiditis, the thyroid produces:
too few thyroid hormones
symptoms of thyroglossal duct cysts
typically asymptomatic may become painful when inflamed
How many parathyroid glands are there?
typically two pairs although some have a fifth
The fluid produced by the thyroid gland that contains thyroid hormones is referred to as:
colloid
How does Hashimoto's appear sonographically?
diffusely heterogeneous, mildly enlarged, and increased vascularity within the gland
What type of gland is the thyroid gland?
endocrine
most common form of thyroid cancer
papillary carcinoma
Hypercalcemia is associated with?
parathyroid adenoma
what is the normal measurement of parathyroid glands?
5.0 x 3.0 x 1.0 mm
What gland releases TSH?
pituitary
muscles lateral to each lobe
sternocleidomastoid muscles
Which muscles are located anterior to the thyroid gland?
strap muscles
