Neck Flashcards
What is a pyramidal lobe
NL variarnt extending superior to the isthmus
What are the following spatial relationships of the thyroid
- Strap muscle
- Sternocleidomastoid
- CCA & IJV
- Minor nerovascular bundle
- Longus collis muscle
- Parathyroid
Anterior - Strap muscle
Anterolateral - Sternocleidomastoid
Lateral - CCA & IJV
Posterior - Minor nerovascular bundle
Posterior - Longus collis muscle
Posterior - Parathyroid
Where does the thyroid arterial supply come and branch from?
Superior thyroid and inferior thyroid arteries
- Superior from ECA
- Inferior from thyrocervical trunk
Where does the thyroid venous supply drain into ?
IJV from Superior and Middle thyroid vein
innomonate from the inferior thyroid vein
What are glands that regulating thyroid hormones?
thyroid ( T3 and T4)
pituitary (TSH)
Hypothalamus (TRH)
The pituitary produces what hormone?
Thyroid stimulating Hormones TSH
What does an Increase of TSH indicate?
HYPOthyroidsm
What is the pituitary regulated by?
Hypothalamus
With a normal functioning pituitary and hypothalamus what are the lab values for hypothyroidism and hyperthyroidism ?
HYPO- Hasho
- Increase TSH Decrease T4/T3
Hyper- Graves
- Decrease TSH Increase T4/T3
What are the two thyroid adenomas?
Follicular and papillary
What thyroid adenoma is the most common?
Follicular
Cystic lesion in they thyroid typically represent why cyst?
Colloid filled cyst
What are the three types of thyroid carcinomas
Papillary, follicular, and medullary
What thyroid carcinomas is the most common?
Papillary
How does thyroid papillary carcinomas spread and how does it look sonographically?
Spreads through lymphatics
Hypoechoic with calcifications
How does thyroid follicular carcinomas spread and how does it look sonographically?
Spreads through blood stream
Homogeneous, solitary, encapsulated
What hormone does thyroid medullary carcinoma secrete and what is this cancer associated with?
Calcitonin
Multiple endocrine neoplasia syndrome
When should a FNA be considered?
> 1cm micro calcifications
1.5cm mostly solid
2cm mixed components
is it growing
does it have ipsilateral lymohnodes (>7mm)
What are the thyroid nodules features for benign or malignancy?
- composition
- echogenicity
- shape
- margination
- calcification
composition B- cystic M- solid
echogenicity B- Hyper M- Hypo
shape M- taller than wide
margination M lobulated or irregular
calcification- mostly suggest M
When does the isthmus need to be FNA?
> 5mm
What are the 5 types of thyroiditis?
Hashimotos
subacute granulomatous
subacute lymohocytic
acute suppurative
riedel struma
What is chronic lymphocytic thyroiditis and what does it look like sonographically?
Hashimotos
autoimmune dz that damages the thyroid and it cant make thyroid hormones. the pituitary senses low thyroid hormones so it send an increase of TSH and causes the thyroid to grow.
- enlarged, coarse echo texture
What is a goiter?
abnormal enlargement of the thyroid
what is it called when a thyroid is producing the correct amount of thyroid hormone?
euthyrooidism
What is the most common causes of a goiter ?
Old iodine deficiency
New hashimotos
What are the two forms of multi nodular goiter
Nontoxic MNG- goiter makes normal amounts of thyroid hormones
Toxic MNG- autonomously functioning resulting in hyperthyroidism
What is graves dz and what does it look like sonographically?
Autoimmune disorder and the immune system produces a protein called thyroid stimulating immunoglobulin and makes the thyroid glade produce too much thyroid hormone. the pituitary senses and that and stops secreting TSH
- Hyporechoic and inhomogenous
What is also seen with graves dz?
Hypervascularity thyroid inferno
- audible bruit, palpable thrill or color evaluation
How many parathyroid glands are there ?
four
Where can a ectopic parathyroid be located?
retrotracheal, mediastinal, intrathyroid, and near carotid bifurcation.
What is the difference between primary and secondary hyperparathyroidism?
Primary- development of adenoma and ONE parathyroid. PTH and serum calcium increase.
Secondary- occurs with CKD and all FOUR parathyroid. Increase serum phosphates. Decrease serum calcium.
What is the treatment of primary hyperparathyroidism?
Surgical excision of the parathyroid adenoma
Where are the following salivary glands and what ducts drain them?
- parotid
- submandibular
- sublingual
Parotid- ant to ear. stensens duct
Submandibular- beneath the jaw. Whartons duct.
sublingual- beneatht the tongue. ant to subman gland. no duct.
What is the most common benign tumor of the parotid gland?
pleomorphic adenoma
What is sialadenitis and what gland is it seen in?
bacterial infection of the salivary gland d/t stone or gland hyposecretion.
parotid.
what is sialolithiasis and what gland is it seen in?
calcified mass or sialoith forms in the submandibular gland.
What is a thyroglossal duct cyst?
- remnant of what?
midline neck mass. cystic dilatation of the duct.
remnant of the thyroid gland migration from the pharyngeal epithelium.
What is a branchial cleft cyst
- remnant of what?
Cystic mass on the llateral aspect of the neck by mandible and sternocleidomastoid muscle.
remnant of embryonic development
What is a cystic hygroma
Congential lymphatic malformation.
cystic mutililoculation near neck.
What is the anatomy of the neck and aortic arch vessels?
Aortic arch vessels
- innominate artery
- left CCA
- left Subclavian.
What vessels come off of the innominate ( brachiocephalic trunk)
RT CCA and RT subclavian art.
What side is the innominate arteries and veins on?
RT innominate arteries
Bilateral innominate veins
What is the first branch of the ECA and ICA?
ECA- Superior thyroid artery
ICA- opthalmic
