ultrasound of the thyroid gland

1. THYROID GLANG
Dr. Doaa i raqi

2. 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

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

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

5. Measure the volume of a thyroid nodule using the same
formula used to calculate the volume of a thyroid lobe: Volume
= π/6(W × D × L(

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

7. 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

8. Thyroglossal duct cyst in the midline. These fluid filled cysts
are very superficial. A reverberation artifact in the anterior third of the
cyst resembles debris in the fluid (white arrow). Posterior to the cyst is
enhancement artifact (black arrow) indicating the sound waves have
passed through fluid

9. This series of enlarged inflamed lymph nodes (calipers)
beneath the sternocleidomastoid muscle could represent infection or
signal the presence of autoimmune thyroiditis

10. Muscle anomaly. Patient was thought to have a nodule in
the right lobe by physical examination. Ultrasound revealed enlargement
of the strap muscle in the right neck (arrow) causing asymmetry;
no nodule is present

11. Hashimoto thyroiditis and Graves’ disease appear similar
on gray-scale ultrasound, but power Doppler will demonstrate
increased blood flow in Graves’ disease
Chronic autoimmune thyroiditis and Graves’ disease are two
forms of autoimmune thyroid disease (AITD). It has been
said that Hashimoto thyroiditis and Graves’ disease are the
same autoimmune thyroid disease but at different ends of the
spectrum. Transition between the two autoimmune thyroid
diseases may occur, which adds to the difficulty in differentiating
between the two (1). The ultrasonographic appearance
Of both Graves’ disease and Hashimoto thyroiditis are similar
As well, with both having a hypoechoic and heterogeneous
echotexture.
While Graves’ disease typically shows marked hypervascularity
with power Doppler analysis, the vascularity of Hashimoto thyroiditis is
variable, ranging from avascular to hypervascular.

12. This enlarged thyroid is typical of Hashimoto thyroiditis
with a hypoechoic but heterogeneous pattern

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

14. Pseudonodules and fibrosis lead to disruption of the architectural
pattern of this enlarged thyroid, which causes the gland to
appear very heterogeneous

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

16. his enlarged flattened paratrachael lymph node (calipers)
in the central compartment is a common finding in Hashimoto
thyroiditis

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

18. a Pure cystic lesion without any internal vascular flow. b Cyst
with comet tail artifactthese small cysts are thought to
represent nonneoplastic benign nodular hyperplasia with its
associated colloid-filled cysts.

19. 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

20. Two views of an intrathyroidal hypoechoic
homogeneous
mass (calipers) in the upper pole of the left lobe
that proved to be a
squamous cell carcinoma on ultrasound-guided
FNA

21. a Gray-scale image of isoechoic nodule with thin
regular
halo. 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

22. 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.

23. Neck lymph node
characteristics
Benign
Malignant
Short/Long Axis <0.5
>0.5
Hilar line Present
Absent
Jugular Deviation or Compression Absent
Present
Microcalcifications Absent
Present
Cystic Necrosis Absent
Present
Vascularity Central Chaotic
periphera

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

25. Power Doppler of the previous lymph node shows
vascularization
of the hilum, which contains small arterioles.
Note there is no
vascularization seen in the periphery of the node.

26. Malignant lymph node. This lymph node (calipers)
is slightly
more 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.

27. Lymph node in longitudinal view shows
compression
of the jugular vein against the carotid. UG FNA
confirmed
malignancy.

28. This irregular rounded lymph node (arrow) was
discovered
because 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.

29. in
right neck beneath the sternocleidomastoid muscle
(scm) and lateral
to 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 had
positive cytology, and Tg was found in the needle
washout.

30. This markedly heterogeneous lymph node
(calipers) contains
scattered calcifications indicating metastatic
papillary carcinoma.a

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

32. 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 to
the thyroid gland (11(.
The presence of an extrathyroidal artery (polar
artery(
feeding an adenoma may be found in 83% of
parathyroid
adenomas . Besides the visualization of the polar
artery,

33. Superior parathyroid adenoma seen in transverse
view(Polar vascular pedicle..(

34. Arc pattern of blood flow.

35. Diffuse blood flow seen within adenoma.

36. Submandibular salivary
glands
Sonography of the normal salivary glands

37. 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.

38. 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.

39. 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.

40. 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

41. 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.

42. 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.

43. This 3D multiplanar reconstruction ultrasound
image shows a large calculus (stone) in the left
submandibular duct (Wharton duct((,

44. Parotid gland cyst(or cystic lesion of benign
tumour(