Thyroid lesions – evaluation with sonography

Ultrasound diagnosis of thyroid gland lesions

1. Thyroid lesions – Evaluation with Sonography Presented BY DR Laith Al hialy

2. thyroid disorders – presentation thyroid gland enlargement ( Goiter ) Palpable nodule Hyperthyroidism Hypothyroidism Cervical - LN

3. Imaging Approach for thyroid nodule 2 – institutions ways US ( 7-10 MHZ liner – with Doppler study) thyroid scintigraphy ( radionuclide 99m Tc , 123 Iodine ) CT , MRI ( none palpable nodule ) FNA Biopsy Palpable Nodule > 1 cm direct biopsy Nodule < 1 cm , Cyst also not appreciated

4. BY sonographic examination what we can detected ? Mass ( nodule Solitary – multiple ) Cyst Calcification Change in thyroid tissue texture Cervical LN

5. Goiter could be presented as retrosternal - upper mediastinal mass

6. Goiter could compress the trachea Before after thyroidectomy

7. Benign lesion Cyst lesion Most common colloid cyst Anechoic , well defined , comet tail appearance Hematoma happen with d egenerative nodule

8. Benign lesion Nodule ( hyperplasic or adenomatous ) Well defined , smooth margin , texture echogenic –isoechoic , fine hypoechoic rim , curvilinear fine calcification with faint acoustic shadow , equivocal vascularity by Doppler, internal hemorrhage

9. Benign lesion Inflammatory condition Hashimoto’s Thyroiditis . typical sonographic features include: a diffusely enlarged gland demonstrating hypoechoic areas with a very disorganized and heterogeneous pattern

10. Malignant lesion Papillary carcinoma is the most common thyroid malignancy 75 % Follicular, Medullary and Aplastic carcinomas and lymphoma make up the remaining 25 % Metastases from lung, breast, and colon cancers ill defined margin , hypoechoic and punctuate –micro calcifications ( psammomatous calcification ) with acoustic shadow Hyper vascularity by Doppler Thick halo 1-2 mm , cervical LN

11. Malignant nodule NHL of thyroid

12. Thyroid nodule isotopes scan Hot nodule cold nodule