THYROID GLANG Dr.Doaa iraqi

Normal appearing thyroid in transverse view. Thyroid is homogeneous and slightly hyperechoic. The lobes are bordered anteriorly by the strap muscles (SM), posteriorly by the longus colli muscle (LC), medially by the trachea, and laterally by the sternocleidomastoid muscle (SCM), carotid artery and jugular vein. A portion of the esophagus (ESO) protrudes behind the tracheal shadow against the medial border of the left lobe

The normal thyroid gland is 2 cm or less in both the transversedimension and depth, and is 4.5–5.5 cm in length& 0.5 mm ithmus.

In the longitudinal view of the thyroid, the length (L) is measured from the cranial to the caudal ends of the lobe

Measure the volume of a thyroid nodule using the sameformula used to calculate the volume of a thyroid lobe: Volume = π/6(W × D × L)

A diffusely enlarged thyroid gland with an isthmus widthof 1.5 cm. Although this could be a hyperplastic normal thyroid, theparenchyma is hypoechoic, suggesting that there is inflammationof the thyroid tissue indicating thyroiditis (Hashimoto’s or Graves’A quick check for enlargement can be done by measuring thewidth of the isthmus; a width >5 millimeters generally indicatesthyroid enlargement.

Hemiagenesis of the right lobe. Initially, this appeared to be a multinodular goiter, but the physical examination was normal. Doppler Revealed a venous plexus occupying the space where the right lobe was absent

Thyroglossal duct cyst in the midline. These fluid filled cystsare very superficial. A reverberation artifact in the anterior third of thecyst resembles debris in the fluid (white arrow). Posterior to the cyst isenhancement artifact (black arrow) indicating the sound waves havepassed through fluid

This series of enlarged inflamed lymph nodes (calipers)beneath the sternocleidomastoid muscle could represent infection or

signal the presence of autoimmune thyroiditis

Muscle anomaly. Patient was thought to have a nodule inthe right lobe by physical examination. Ultrasound revealed enlargementof the strap muscle in the right neck (arrow) causing asymmetry;

no nodule is present

Hashimoto thyroiditis and Graves’ disease appear similaron gray-scale ultrasound, but power Doppler will demonstrate

increased blood flow in Graves’ disease

Chronic autoimmune thyroiditis and Graves’ disease are twoforms of autoimmune thyroid disease (AITD). It has beensaid that Hashimoto thyroiditis and Graves’ disease are thesame autoimmune thyroid disease but at different ends of thespectrum. Transition between the two autoimmune thyroiddiseases may occur, which adds to the difficulty in differentiatingbetween the two (1). The ultrasonographic appearanceOf both Graves’ disease and Hashimoto thyroiditis are similarAs well, with both having a hypoechoic and heterogeneousechotexture.

While Graves’ disease typically shows marked hypervascularitywith power Doppler analysis, the vascularity of Hashimoto thyroiditis is variable, ranging from avascular to hypervascular.

This enlarged thyroid is typical of Hashimoto thyroiditiswith a hypoechoic but heterogeneous pattern

Swiss cheese.” Diffuse small cystic lesions (diffuse laks of lymphocytes) scattered throughout normal appearing thyroid represent an early stage of Hashimoto thyroiditis

Pseudonodules and fibrosis lead to disruption of the architecturalpattern of this enlarged thyroid, which causes the gland toappear very heterogeneous

These enlarged flattened lymph nodes under the sternocleidomastoid muscle are commonly seen in early Hashimoto thyroiditis and are often a clue to early diagnosis.

his enlarged flattened paratrachael lymph node (calipers)in the central compartment is a common finding in Hashimotothyroiditis

a Gray-scale image of Graves’ disease with heterogeneousechogenicity. b Color-flow Doppler image of Graves’ disease demonstrating increased vascularity.

a Pure cystic lesion without any internal vascular flow. b Cystwith comet tail artifactthese small cysts are thought to represent nonneoplastic benign nodular hyperplasia with its

associated colloid-filled cysts.

a Gray-scale image of cystic papillary cancer. Note icrocalcification in solid area. B Color-flow Doppler image of same nodule demonstrating increased vascularity in the papilliform solid area

Two views of an intrathyroidal hypoechoic homogeneousmass (calipers) in the upper pole of the left lobe that proved to be asquamous cell carcinoma on ultrasound-guided FNA

a Gray-scale image of isoechoic nodule with thin regularhalo. Cytology is benign. b Color-flow Doppler image of same nodule indicating the halo corresponds with peripheral vascularity. c Thick, irregular and incomplete halo surrounding solid iso- to hyperechoic nodule. Histology is Hürthle cell cancer

IN Normal postoperative left neck.the common carotid artery and the internal jugular vein have migrated medially next to the trachea. The vein is anterior to the artery but closely adhered to it. Hyperechoic connective tissue has filled in the thyroid bed.

Neck lymph node characteristics

Benign MalignantShort/Long Axis <0.5 >0.5Hilar line Present AbsentJugular Deviation or Compression Absent PresentMicrocalcifications Absent PresentCystic Necrosis Absent PresentVascularity Central Chaotic periphera

Benign lymph node. The normal neck contains scores oflymph nodes, some of which are easily seen with ultrasound. Thislymph node (calipers) appears benign because it is flat with a short/long axis ratio <0.5.

Power Doppler of the previous lymph node shows vascularizationof the hilum, which contains small arterioles. Note there is novascularization seen in the periphery of the node.

Malignant lymph node. This lymph node (calipers) is slightlymore rounded, with a short/long axis ratio > 0.5 in the transverse view. Note the absence of a hilar line, which makes this node suspicious. An UG FNA was needed to confirm malignancy.

Lymph node in longitudinal view shows compressionof the jugular vein against the carotid. UG FNA confirmedmalignancy.

This irregular rounded lymph node (arrow) was discoveredbecause of the separation of the jugular from the carotid. The calcification at 3:00 o’clock indicates it is malignant, but UG FNA is necessary before surgery.

Transverse view of a metastatic lymph node (calipers) inright neck beneath the sternocleidomastoid muscle (scm) and lateralto the carotid artery. The node is impinging upon the jugular vein (J).The short/long axis ratio is >0.5 and no hilar line is seen. UG FNA hadpositive cytology, and Tg was found in the needle washout.

This markedly heterogeneous lymph node (calipers) containsscattered calcifications indicating metastatic papillary carcinoma.a

This 2cm rounded lymph node in the right neck is 80%cystic; note the distal enhancement. Although occasionally seen intuberculosis, cyst formation within a lymph node usually indicatesmetastatic papillary carcinoma.

parathyroid

Normal parathyroid glands(4) are ovoid, or bean-shaped, and measure approximately 3 by 5 mm in size.The majority of parathyroid adenomas are located adjacent to, but separate from, the posterior aspect of the thyroid.

The most typical imaging characteristic of parathyroid adenomas is

the homogeneously hypoechoic echogenicity in relation tothe thyroid gland (11).

The presence of an extrathyroidal artery (polar artery)feeding an adenoma may be found in 83% of parathyroidadenomas . Besides the visualization of the polar artery,

other patterns such as the vascular arc pattern and diffuseflow within the adenoma have also been described

Superior parathyroid adenoma seen in transverse

view(Polar vascular pedicle..)

Arc pattern of blood flow.

Diffuse blood flow seen within adenoma.

Submandibular salivary glands

Sonography of the normal salivary glands

The above ultrasound images of the normal submandibular salivary glands show homogenous echotexture and fine soft tissue echogenicity. The color doppler image shows the gland to be vascular. Echogenicity appears slightly less than that of a

normal thyroid gland  .

The parotid gland is much larger than the submandibular salivary gland. Its transverse diameter is considerably smaller than the coronal dimensions. The parotid shows almost the same texture and echogenicity as the submandibular gland .

Sonography of the parotid glands in this patient reveal: a) bilateral microabscess formation with b) swollen glands c) hypoechoic lesions. These ultrasound images suggest inflammation s/o parotitis .

hypoechoic, well defined masse which show no significant acoustic enhancement. Fine septae are seen within the mass . Color doppler imaging shows multiple vessels within the mass with typical low velocity flow. These findings suggest either pleomorphic adenoma of the parotids

Marked swelling of the right parotid gland , multiple anechoic and hypoechoic cystic spaces within the right parotid gland & marked augmentation of vascularity. These ultrasound images suggest right parotid abscess .

Marked swelling of the right parotid gland , multiple anechoic and hypoechoic cystic spaces within the right parotid gland & marked augmentation of vascularity. These ultrasound images suggest right parotid abscess .

This 3D multiplanar reconstruction ultrasound image shows a large calculus (stone) in the left

submandibular duct (Wharton duct) ,)

Parotid gland cyst(or cystic lesion of benign tumour)