Thyroid Ultrasonography: clinical and radiological correlations

Transcription

1 Thyroid Ultrasonography: clinical and radiological correlations Dr.M.Thijs Radiology

2 Anatomy Inflammatory Thyroid Disease Benign lesions Thyroid tumors Thyroglossal duct cyst

3 Anatomy Transverse Longitudinal

4 Anatomy

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6 Inflammatory Thyroid Disease

7 Autoimmune thyroiditis Hashimoto s thyroiditis Graves disease

8 34 yr: Hashimoto s thyroidits, hypothyroid fase

9 Hashimoto s thyroiditis

10 33 yr: Postpartum, hypothyroid

11 Hashimoto s thyroiditis: endstage 58 yr

12 Graves disease: 32 yr

13 Graves disease Thyroid inferno Ralls et al. (1988)

14 Relapse Graves postpartum

15 Relapse Graves postpartum

16 Graves disease, 45 yr

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18 Subacute granulomatous thyroiditis. De Quervain thyroiditis. Clinical presentations vary between focal and diffuse disease

19 46 yr: Since 1 month painful thyroid Areas of painful induration

20 Granulomatous thyroiditis.

21 41 yr

22 : right lobe involved Left side O.K.

23 After 8 months: complete recovery

24 33 yr: De Quervain Thyroiditis: diffuse disease

25 Amiodarone-induced destructive thyroiditis

26 Amiodarone.no typical sonographic pattern.normal appearance is possible.hypovascular

27 Benign lesions Thyroid adenomas Cystic lesions Goiter

28 True Thyroid Cyst

29 Colloidreflections: Comet s Tail

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31 Goiter

32 Diffuse hyperplasia: homogenous Iodine deficiency: 34 yr Burundi living in Belgium for 5 years

33 Multinodular goiter longitunal transversal

34 83 yr : breathless when lying down Extreme narrowing of the trachea over a length of 5 cm

35 Thyroid tumors

36 Benign Tumors of the Follicular Epithelium: Follicular adenoma, variant Hürthle cell adenoma Differentiated Carcinomas of the Follicular Epithelium Papillary Thyroid Carcinoma Follicular Thyroid Carcinoma, variant Hürthle cell carcinoma Dedifferentiated Carcinoma: Anaplastic Thyroid Carcinoma

37 Follicular Adenoma Hürthle cell adenoma Follicular Adenocarcinoma Hürthle cell adenocarcinoma

38 23 yr: Follicular Adenoma

39 23 yr: Follicular Adenoma

40 25 yr: Follicular Carcinoma

41 79 yr: Follicular Carcinoma 9 cm

42 yr: Evolution Follicular Carcinoma

43 : almost two years later

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46 Hürthle cell adenoma: 58 yr A completely uniform halo around a nodule: suggestive of benignity

47 Hürthle cell carcinoma: 40 yr A complete avascular nodule is very unlikely to be malignant.

48 Papillary Thyroid Carcinoma Lymphatic spread Slow growth rate Multifocal

49 50 yr: Cystic papillary carcinoma

50 51 yr: Papillary carcinoma An ill-defined and irregular margin in a thyroid tumor suggests malignant infiltration of adjacent thyroid parenchyma

51 51 yr: Papillary carcinoma

52 Size of a nodule The size of a nodule is not helpful for predicting or excluding malignancy. There is a common but mistaken practice of selecting the largest nodule in a multinodular thyroid for FNA. The Society of Radiologists in Ultrasound recently recommended that the selection of a nodule for FNA in a multinodular thyroid be based primarily on US characteristics rather than nodule size Although nodules with a size of more than 4 cm are slightly more likely to be malignant than are smaller nodules, it is well known that benign nodules can reach a large size Jenny K. Hoang, Wai Kit Lee, Michael Lee, Daryl Johnson, and Stephen Farrell: US Features of Thyroid Malignancy: Pearls and Pitfalls RadioGraphics 2007; 27:

53 31 yr: Multifocal Papillary Carcinoma

54 31 yr: Multifocal Papillary Carcinoma

55 36 yr: Follicular variant of Papillary Carcinoma

56 40 yr: Papillary Carcinoma: evolution after one year

57 19 yr: Adenopathies PapillaryCarcinoma.

58 17 yr: Papillary Carcinoma: numerous adenopathies

59 66j 1996: Thyroidectomy Papillary Carcinoma 2006: cystic metastases

60 Undifferiated: Anaplastic thyroid carcinoma Complex echotexture. Hyporeflective. Huge calcifications. Variable degrees of vascularisation, often poor.

61 66 yr: Anaplastic thyroid carcinoma

62 2 years later

63 78 yr

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65 80 yr: Anaplastic Carcinoma Isthmus

66 Medullary Thyroid Carcinoma Malignant tumor of the calcitonin - secreting parafollicular C - cells = medullary cells of the thyroid (non epithelial) Metastatic dissemination in partracheal and latero-cervical lymphnodes. Distant metastases (liver, lungs )

67 40 yr: Medullary Carcinoma right lobe MTC is usually firm in consistency, hypoechoic isoechoic Calcifications. Peripheral and central hypervascularity.

68 40 yr: Medullary Carcinoma right lobe. Multiple adenopathies. Calcitonine above measurable limits.

69 Mediastinal adenopathies and lungmetastases

70 Thyroid Metastases

71 49 yr: metastasis of lung cancer

72 74 yr: RCC

73 Conclusion Although there is some overlap between US appearance of benign nodules and that of malignant nodules, certain US features are helpful in differentiating between the two.

74 Thyroglossal duct cyst

75 46 yr Inflammatory surinfected thyroglossal duct cyst.

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77 Before and after US-guided puncture with evacuation of 3 ml haemorrhagic fluid