General Sono 2, Face and Neck
Cysts and cystic nodules
- related to degeneration of an adenoma - sonographic findings correspond to degenerative changes
sialolithiasis
- salivary duct stones - Symptoms: Swelling of a salivary gland and dry mouth
All of the following are diagnostic findings of a likely benign thyroid nodule except: - Anechoic nodule - Eggshell calcification - Hyperechoic nodule - Cold nodule
cold nodule
Which of the following would more likely be a malignant thyroid nodule? - Cold nodule - Hot nodule
cold nodule
Sterncleidomastoid muscles
large muscles anterolateral to the thyroid
thyperthyroidism
oversecretion of thyroid homones
What are the clinical signs of De Quervains
- Usually viral - Diffuse enlargement - tenderness/mild to severe pain - transient hyperthyroidism
follicular carcinoma
- adenocarcinoma - slow growing enlargement of gland - clinical signs: more common in females, microcalcifications seen on radiograph - sonographic findings: indistinguishable from adenoma, microcalcifications, possibly irregular shape
Cystic hygroma
- congenital lymphatic malformation commonly posterolateral on neck - webbed neck - sonographic findings: thin walled, cytic multiloculated mass
sonographic appearance of graves disease
- diffuse hypoechoic thyroid texture - hypervascular
Causes of nodular disease
- graves' disease - thyroiditis neoplasm - cyst - inadequate supply of hormones
parathyroid hyperplasia
enlargement of multiple parathyroid glands
secondary hyperparathyroidism
enlargement of parathyroid glands in patients with renal failure or vitamin D deficiency
Which of the following is associated with congenital muscular torticollis? - Fibromatosis colli - Branchial cleft cyst - Pleomorphic adenoma - Sialadenosis
fibromatosis colli
symptoms of goiter
enlargement of thyroid
saliva
fluid produced by the salivary glands which aids in digestion
symptoms of Graves disease
symptoms associated with hyperthyroidism
colloid
the fluid produced by the thyroid that contains thyroid hormones
De Quervian's thyroiditis
viral infection of the thyroid that causes inflammation
primary hyperparathyroidism
over secretion of parathyroid hormone, usually from a parathyroid adenoma
What is the first branch of the external carotid artery? - Internal carotid artery - Optic artery - Superior thyroid artery - Inferior thyroid artery
superior thyroid artery
Wharton duct
the duct that drains the submandibular gland
Stensen duct
the main duct of the parotid gland
thyroid inferno
the sonographic appearance of hypervascularity demonstrated with color Doppler imaging of the thyroid gland
Where is the thyroid located?
The right and left lobes are located anteriolateral to the trachea and esophagus
What is hypothyroidism
Under secretion of thyroid hormones
A cystic mass noted at the mandibular angle is most likely a: - Branchial cleft cyst - Follicular adenoma - Thyroglossal duct cyst - Parathyroid adenoma
branchial cleft cyst
Parathyroid glands control the release and absorption of which nutrient? - Thyroxine (T4) - Triiodothyronine (T3) - Calcitonin - Calcium
calcium
Hashimoto's thyroiditis
chronic inflammation of the thyroid gland caused by the formation of antibodies against normal thyroid tissue
cervical lymphadenopathy
enlargement of the cervical lymph nodes
goiter
enlargement of the thyroid gland that can be focal or diffuse; multiple nodules may be present
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 - Common carotid artery - Internal jugular vein - Sternothyroid
esophagus
hypothyroidism
a condition that results from the under production of thyroid hormones
What muscles are anterior to the thyroid
-The strap muscles: Sternohyoid, omohyoid, sternothyroid - sternocleidomastoid
What is nodular disease
Goiter, enlargement of the thyroid
thyroid stimulating hormone./ TSH
a hormone secreted by the pituitary gland that stimulates the thyroid gland to secrete thyroxine and tri-iodothyronine
parathyroid hormone
a hormone that is secreted by papathyroid glands, which regulates serum calcium levels
what is the sonographic appearance of adenopathy, cervical
- loss of normal flattened, elongated oval lymph node shape with increase in anteroposterior dimensions, loss of fatty hilum
What are the laboratory test that would be used for any thyroid concerns
Serum - triiodothyronine/T3 - thyroxine/T4 - calcitonin - thyroid stimulating hormone/TSH
pyramidal lobe
a normal variant of the thyroid gland in which there is a superior extension of the isthmus
What are the clinical signs of hyperthyroidism
- Dramatic increase in metabolic rate - weight loss - increased appetite - nervous energy - tremors - excessive sweating - heat intolerance - cardiac palpitations - exopthalmos
sonographic appearance of medullary thyroid cancer
- discrete tumor in one lobe or numerous nodules involving both lobes - possible focal hemorrhage - necrosis - coarse calcification - reactive fibrosis in tumor
A normal lymph node will not measure greater than: - 8 mm - 5 mm - 12 mm - 10 mm
10mm
Sialadenosis
benign, painless enlargement of a salivary gland or glands
Which abnormality is associated with the sonographic findings of a thyroid inferno? - Hashimoto thyroiditis - Graves disease - Hyperparathyroidism - Cervical lymphadenopathy
graves disease
A patient with hypercalcemia presents to the sonography department for a neck sonogram. What abnormality in the neck should be suspected? - Parathyroid adenoma - Parotid gland enlargement - Thyroid papillary carcinoma - Hashimoto thyroiditis
parathyroid adenoma
Which of the following is elevated serum calcium associated? - Graves disease - Thyroglossal duct cyst - parathyroid adenoma - thyroid adenoma
parathyroid adenoma
sonographic appearance Hasimoto's disease/chronic lymphocytic thyroiditis
- ill defined hypoechoic areas separated by thickened fibrous strands - coarse but overall homogeneous thyroid echotexture - frequently hypervascular
symptoms of parathyroid adenoma/parathyroid hyperplasia
- increased levels of serum calcium and parathyroid hormone - hypophosphatasia - increased renal excretion of calcium - nephrocalcinosis - renal stones
sonographic appearance of follicular tumors
- may be hyperechoic, isoechoic, hypoechoic, or mixed with well defined areas of different echogenicity within - focal cystic components may be present - usually have a "spoke-and-wheel" like vascularity with marked circulation in peripheral halo
A thyroid isthmus that measures greater than __________is indicative of thyroid enlargement. - 8 mm - 5 mm - 12 mm - 10 mm
10mm
Normally, how many parathyroid glands are found within the adult neck? 3 4 6 8
4
pleomorphic adenoma
benign and most frequent tumor of the salivary glands, most commonly seen in the parotid gland
thyroglossal duct cysts
benign congenital cysts located within the midline of the neck superior to the thyroid gland and near the hyoid bone - Symptoms: midline mass, superior to the thyroid
The fluid produced by the thyroid gland that contains thyroid hormones is referred to as: - Thyroxine - Calcitonin - Colloid - Triiodothyronine
colloid
dysphagia
difficulty swallowing
All of the following are sonographic findings of an abnormal lymph node except: - Rounded shape - Echogenic hilum - Calcifications - Enlargement
echogenic hilum - with an abnormal lymph node, the patient will often have painful palpable neck masses
All of the following are sonographic findings of malignant thyroid nodules except: - Internal calcifications - Hyperechoic mass - Cervical node involvement - Solitary mass
hyperechoic mass
sialadenitis
inflammation of a salivary gland or glands
Which of the following is the most common form of salivary gland cancer? - Mucoepidermoid carcinoma - Papillary carcinoma - Ancillary carcinoma - Medullary carcinoma
mucoepidermoid carcinoma
sonographic appearance of branchial cleft cysts
noninfected- thin uniform wall surrounding homogeneous mass; usually fluid filled infected- low level echoes, layering effect, or complex appearance
sonographic appearance of goiter
nonspecific
psammoma bodies
round, punctuate calcific deposits
Which of the following is the term for stones within the salivary duct? - Sjögren syndrome - Torticollis - Cervical lymphadenopathy - Sialolithiasis
sialolithiasis
Which muscle does fibromatosis colli mostly affect? - Omohyoid - Longus colli - Sternocleidomastoid - Infrahyoid
sternocleidomastoid
Which muscles are located lateral to each thyroid lobe? - Sternocleidomastoid - Longus colli - Sternohyoid - Omohyoid
sternocleidomastoid
Which muscles are located anterior to the thyroid gland? - Sternocleidomastoid - Longus colli - Thyrocervical trunk - Strap
strap
thyroglossal duct
the embryonic duct that is located from the base of the tongue to the midportion of the anterior neck
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 malignant potential
Hashimoto thyroiditis
the most common cause of hypothyroidism in the United States
papillary carcinoma
the most common form of thyroid cancer
mucoepidermoid carcinoma
the most common malignancy of the salivary glands; typically starts in the parotid gland
thyroidectomy
the surgical removal of the thyroid or part of the thyroid
Benign congenital cysts located superior to the thyroid gland near the hyoid bone are referred to as: - Branchial cleft cysts - Follicular adenomas - Thyroglossal duct cysts - Parathyroid adenomas
thryoglossal duct cysts
What are some causes of hyperthyroidism
- Abnormal hormone secretion - localized neoplasm cause over production of hormones - Graves' disease
sonographic appearance of anaplastic thyroid cancer
- inhomogeneous - hypoechoic invasive solid mass
How are the right and left lobe of the thyroid connected
By the isthmus
Adenoma
Encapsulated nodule - sonographic findings include peripheral halo/color Doppler, cystic area/degeneration, rim calcifications
What is toxic multinodular goiter
Graves' disease
What is thyroiditis
Inflammation of the thyroid causing swelling and tenderness
What element is necessary for the production of thyroxine
Iodine
What is hyperthyroidism?
Over secretion of thyroid hormones
Which of the following is the duct that drains the submandibular gland? - Stensen duct - Wharton duct - Seigel duct - Partridge duct
Wharton duct
hyperthyroidism
a condition that results from the overproduction of thyroid hormones
Sjögren syndrome
an autoimmune disease that affects all glands that produce moisture, leading to dysfunction of the salivary glands and severe dryness of the eyes, nose, skin, and mouth
goiter
an enlarged, hyperplastic thyroid gland
graves' disease
autoimmune disorder of diffuse toxic goiter characterized by bulging eyes
adenoma
benign thyroid neoplasm characterized by complete fibrous encapsulation
Which vascular structure is located closest to the thyroid lobes? - External carotid vein - External carotid artery - Internal jugular vein - Common carotid artery
common carotid artery
thryoglossal duct cyst
congenital anomalies tat present in midline of the neck anterior to the trachea
cystic hygroma
cystic neck mass caused by malformations of the cervical thoracic lymphatic system
nodular hyperplasia
degenerative nodules within the thyroid
dyspnea
difficulty breathing
hyperparathyroidism
disorder associated with elevated serum calcium level, usually caused by a benign parathyroid adenoma
adenopathy
enlargement of the lymph nodes
What is the most common cause of hyperthyroidism? - Graves disease - Hashimoto thyroiditis - Papillary carcinoma - Parathyroid adenoma
graves disease
Strap muscles
group of three muscles, sternothyroid, sternohyoid, and omohyoid, they lie anterior to the thryroid
thyroiditis
inflammation of the thyroid
A 45-year-old female patient 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? - Torticollis - Lymphadenopathy - Sialadenitis - Graves disease
lymphadenopathy
punctate
marked with dots
papillary carcinoma
most common form of thyroid malignancy
medullary carcinoma
neoplastic growth that accounts for 10% of thyroid malignancies
multinodular goiter
nodular enlargement of the thyroid associated with hyperthyroidism
symptoms of cystic hydroma
painless, soft, semifirm mass in posterior neck
Which gland is located immediately anterior to the ear? - Submandibular gland - Sublingual gland - Thyroid gland - Parotid gland
parotid gland
symptoms of papillary thyroid cancer
possible palpable mass
pyramidal lobe
present in small percentage of patients, the thyroid tissue will extend superiorly from the isthmus
Psammoma bodies are - Hypoechoic structures - Comet-tail artifacts emanating from inside a colloid mass - punctate calcific deposits - mural or wall nodules within a solid mass
punctate calcific deposits
The superior extension of the thyroid isthmus is referred to as the: - Thyroglossal duct - Branchial cleft - Yodeler's lobe - Pyramidal lobe
pyramidal lobe
anaplastic carcinoma
rare, undifferentiated carcinoma occurring in middle age
euthyroid
refers to a normal functioning thyroid
branchial cleft cyst
remnant of embryonic development that appears as a cyst in the neck
isthmus
small piece of thyroid tissue that connects the right and left lobes of the gland
Graves disease
the most common cause of hyperthyroidism that produces bulging eyes, heat intolerance, nervousness, weight loss, and hair loss
Which of the following is the hormone that is the most abundantly produced by the thyroid? - Thyroxine - Iodine - Triiodothyronine - Calcitonin
thyroxine
microcalcifications
tiny echogenic foci within a nodule that may or may not shadow
in the presence of Hashimoto thyroiditis, the thyroid produces - too many thyroid hormones - too much calcium - to few thyroid hormones - too much iodine
to few thyroid hormones
torticollis
twisted neck
Papillary Carcinoma
- most common thyroid malignancy - characterized by tiny calcifications called psammoma bodies - major route of spread is through regional lymphatic system - clinical signs: asymptomatic, painless lump in neck - sonographic appearance: hypoechoic, microcalcifications, hypervascularity, possible cervical lymph node metastasis
symptoms of anaplastic thyroid cancer
- painful rapid enlargement of nodule; may mimic thyroiditis
symptoms of Hasimoto's disease/chronic lymphocytic thyroiditis
painless, diffuse enlarging gland
fibromatosis colli
—a rare, pediatric fibrous tumor located within the sternocleidomastoid muscle
branchial cleft cysts
—benign congenital neck cysts found most often near the angle of the mandible
Lymphoma
- clinical signs: rapidly growing mass in neck, may be associated with pre-existing Hashimoto's thyroiditis - sonographic findings: non vascular, hypoechoic lobulated mass, possible area of cystic necrosis, heterogeneous adjacent thyroid is thyroiditis is also involved
Which of the following best describes the normal appearance of a cervical lymph node? - A hypoechoic, oblong structure with a distinct echogenic hilum - A rounded, echogenic structure with small calcifications - A solid, hypoechoic mass that measures greater than 1 cm - A solid, echogenic mass that measures less than 1 cm
A hypoechoic, oblong structure with a distinct echogenic hilum
What are the causes of toxic multinodular goiter
Autoimmune hyperthyroidism
What is the most common cause of hypothyroidism? - Graves disease - Hashimoto thyroiditis - Papillary carcinoma - Parathyroid adenoma
Hashimoto thyroiditis
What muscles are posterior to the thyroid
Longus colli muscle
What is the function of the thyroid gland
Maintains body metabolism, growth, and development
fine needle aspiration
invasive procedure used to obtain a small specimen from a specific lesion
All of the following are hormones produced by the thyroid except: - Thyroxine - Iodine - Triiodothyronine - Calcitonin
iodine
Which of the following does the thyroid gland utilize to produce its hormones? - Colloid - Iodine - Iron - Calcium
iodine
serum calcium
laboratory value that is elevated with hyperparathyroidism
Which muscles are located posterior to each thyroid lobe? - Sternocleidomastoid - Longus colli - Sternohyoid - Omohyoid
longus colli
hypophosphatasia
low phosphatase level, which can be seen with hyperparathyroidism
scintigraphy, thyroid
nuclear medicine study in which a radiopharmaceutic is used to examine the thyroid gland
diffuse nontoxic goiter
occurs as a compensatory enlargement of the thyroid gland resulting in thyroid hormone deficiency
follicular carcinoma
occurs as a solitary malignant mass within the thyroid gland
hypothyroidism
underactive thryoid hormone
symptoms of follicular tumors
usually asymptomatic possibly palpable
symptoms of thyroglossal duct cyst
usually asymptomatic, may cause pain if infeccted
symptoms of adenopathy, cervical
variable depending on cause, possibly palpable
longus colli muscles
wedge shaped muscle posterior to the thyroid lobes
sonographic appearance of thyroglossal duct cysts
well-defined, thin walled, anechoic mass with through enhancement; mass with mixed echogenicity suggests infection of the cyst; midline or just off midline in position, can be found at any level from the base of the tongue to the isthmus of the thyroid gland
what is the sonographic appearance of an adenoma
well-marginated, mostly cystic with internal debris
What are some causes for hypothyroidism
- Low intake of iodine - thyroid hormone failure - diseases of the hypothalamus or pituitary
What are some clinical signs of hypothyroidism
- Myxedema - weight gain - hair loss - increased tissue around the eyes - lethargic - intellectual and motor slowing - cold intolerance - constipation - deep/husky voice
What are the types of nodular disease
- Nodular hyperplasia - multinodular - adenomatous - simple/non-toxic - multinodular/toxic
correlative and/or prior imaging
- Nuclear Medicine - Computed tomography - Magnetic resonance - radiography - extracranial duplex doppler examination
What are indications for an ultrasound examination of the thyroid/neck
- Palpable enlargement - abnormal thyroid hormone levels - palpable mass in the neck or thyroid - swelling of the neck - asymmetry of the neck - redness and or tenderness
colloid cyst
- asymptomatic palpable thyroid mass - anechoic cyst with comet tail
What are the clinical signs of Hashimoto's
- most common form - autoimmune/chronic inflammation - diffuse enlargement/possibly asymmetric - painless/may develop mild pain overtime - eventual hypothyroidism
What are benign mass of the thyroid
- Cyst and cystic nodules - adenomas
What are the two types of thyroiditis
- De Quervians - Hashimoto's
Sonographic appearance of toxic multinodular goiter
- Diffuse enlargement - hypoechoic without palpable nodules - markedly increased vascularity: thyroid inferno
What is the clinical signs of toxic multinodular goiter
- Hypermetabolism - diffuse toxic goiter - exopthalmos - cutaneous formation: periorbital, dorsum of feet
Symptoms of an adenoma
- usually asymptomatic - possibly palpable
What are the sonographic findings for nodular disease
- Usually enlarged - nodular - possibly heterogeneous - focal scarring, ischemia, necrotic cyst formation
What is the endocrine function of the thyroid
- secretes hormones: thyroxine/T4, triiodothyronine/T3, affect metabolic rate - calcitonin affects calcium metabolism - respond to thyroid stimulating hormone which is secreted by the pituitary gland and it controls thyroid hormone secretions
sonographic appearance of parathyroid adenoma/parathyroid hyperplasia
- single or multiple oval homogeneous low- echogenicity solid masses - if minimally enlarged, may not be detected sonographically
What is the venous drainage for the thyroid
- superior and middle thyroid veins into jugular vein - inferior thyroid vein into innominate vein
What is the arterial supply to the thyroid
- superior thyroid, right and left - inferior thyroid, right and left
sonographic appearance of cystic hygroma
- usually multiloculated homogeneous cystic masses
sonographic appearance of papillary thyroid cancer
- variable but almost always mass of low echogenicity; wide, irregular halo surrounding nodule often multicentric; internal microcalcifications (psammoma bodies) are a common and specific finding
symptoms of medullary thyroid cancer
-possible palpable nodule - increased calcitonin level
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? - Hashimoto thyroiditis - Graves disease - Hyperparathyroidism - Cervical lymphadenopathy
Graves disease
calcitonin
a thyroid hormone that is important for maintaining a dense, strong bone matrix and regulating blood calcium level
What type of gland is the thyroid gland? - Endocrine - Exocrine - Both A and B - Neither A nor B
endocrine
symptoms of branchial cleft cyst
painless mass on lateral neck, if infected, may be tender and painful
Which of the following is the most common form of thyroid cancer? - Follicular - Anaplastic - Lymphoma - Papillary
papillary
Which of the following is an autoimmune disease that affects the glands that produce moisture, leading to dysfunction of the salivary glands, and dryness of the eyes, nose, skin, and mouth? - Wharton syndrome - Sjögren syndrome - Stenson syndrome - Sialadenosis syndrome
- Sjögren syndrome
Thyroglossal duct cysts
- congenital anaomaly midline and anterior to trachea - clinical signs: palpable midline mass, pain is associated with hemorrhage or infection - sonographic findings: cystic mass in midline anterior to the trachea, internal echoes caused by hemorrhage or infection
Medullary carcinoma
- less common thyroid malignancy - clinical signs: hard, bulky mass, abnormal serum calcitonin levels - sonographic finding: solid mass with calcifications, lymphadenopathy
What are the malignant masses of the thyroid
- papillary carcinoma - medullary carcinoma - anaplastic carcinoma - follicular carcinoma - lymphoma
What is the normal variant of the thyroid that arises from the isthmus
Pyramidal lobe
Is the sonographic appearance of thyroiditis
- possibly hypoechoic/normal echotexture - thick, fiber strands - increased vascularity color Doppler
Anaplastic carcinoma
- rare thyroid malignancy - clinical signs: hard, fixed mass, rapid growth, pain, pressure, tenderness, locally invasive - sonographic findings: hypoechoic mass, possibly irregular, diffuse glandular involvement, invasion of surrounding structures
Branchial cleft cyst
- remnant of embyronic development usually lateral to thyroid - sonographic findings: primarily cystic, possible low level echogenicity, solid components
