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Abdominal Sonography > Neck > Flashcards

Neck Flashcards

0
Q

How does normal thyroid parenchyma appear on ultrasound?

A

Homogeneous medium level echoes

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1
Q

What is the pyramidal lobe of the thyroid?

A

Normal variant extending superior to the isthmus

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2
Q

How do the strap muscles of the neck appear on ultrasound?

A

Sternohyoid and sternothyroid

Sonolucent bands along the anterior surface of the thyroid gland

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3
Q

Where is the common carotid artery and the internal jugular vein in relation to the thyroid lobes?

A

Directly lateral to the thyroid lobes with the internal jugular vein lateral to the carotid artery

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4
Q

What muscle is posterior to the thyroid?

A

Longus colli muscle

Wedge shaped sonolucent structure adjacent to the cervical vertebrae

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5
Q

What is the minor neurovascular bundle composed of?

A

Recurrent laryngeal nerve and inferior thyroid vessels

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6
Q

Are the parathyroid glands typically visualized with ultrasound?

A

NO - due to their small size

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7
Q

How does the trachea appear on ultrasound?

A

Midline, characteristic curvilinear reflecting surface with associated reverberation artifact

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8
Q

How does the esophagus appear on ultrasound?

A

Transverse – target sign

Usually hidden by the trachea

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9
Q

Where does the thyroid arterial supply come from?

A

Superior thyroid artery - from external carotid artery

Inferior thyroid artery - from thyrocervical trunk

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10
Q

Where does the venous blood from the thyroid drain into?

A

Internal jugular vein via the superior and middle thyroid veins
Innominate veins via inferior thyroid veins

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11
Q

Which glands regulate thyroid hormones?

A

Thyroid
Pituitary
Hypothalamus

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12
Q

Where is TSH produced?

A

Pituitary

Stimulates the thyroid to produce thyroid hormones

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13
Q

What is usually the first indication of hypothyroidism?

A

Increase in TSH

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14
Q

Which gland regulates the pituitary gland?

A

Hypothalamus

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15
Q

What is the percent of the US population with evidence of nodular thyroid disease?

A

50% of the United States population

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16
Q

What is the overall incidence of cancer in patients with thyroid nodules?

A

10–13%

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17
Q

What is the most commonly encountered benign thyroid nodule?

A

Follicular adenoma

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18
Q

What can commonly occur within these benign nodules resulting in cystic thyroid nodules?

A

Hemorrhage or necrosis

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19
Q

What are risk factors for thyroid cancer?

A

Age – 60yo
Head and neck irradiation
Family history of thyroid cancer

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20
Q

What are physical findings of thyroid cancer?

A 
Recent palpable neck mass
Mass is firm and nontender
Mass moves with swallowing
Enlarged cervical lymph nodes
Hoarseness
Trouble swallowing or breathing
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21
Q

What is the most common primary thyroid cancer?

A

Papillary carcinoma

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22
Q

How does papillary carcinoma appear on ultrasound?

A

Hypoechoic mass, with possible calcifications

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23
Q

What is the major route for the spread of papillary carcinoma?

A

Through the lymphatics to nearby cervical lymph nodes

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24
Q

What accounts for 10 to 20% of thyroid cancers?

A

Follicular carcinoma

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25
Q

How do follicular cancers tend to spread?

A

Via the bloodstream

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26
Q

What does medullary carcinoma typically secrete?

A

Calcitonin

Associated with multiple endocrine neoplasia syndrome

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27
Q

How does anaplastic carcinoma behave?

A

Aggressive, rapidly invades surrounding tissue causing airway obstruction

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28
Q

How are thyroid masses clinically evaluated?

A

Fine needle aspiration with cytologic evaluation

29
Q

When should FNA be considered?

A 
> 1 cm with microcalcifications
> 1.5 cm that is predominantly solid
> 2 cm that has mixed components
Nodule demonstrating growth
Nodule with ipsilateral abnormal lymph nodes
30
Q

How is ultrasound used to differentiate thyroid nodules from other cervical masses?

A

Differentiate from cystic hygromas, glossal duct cysts, or enlarged lymph nodes

31
Q

Which factors improve the positive predictive value of ultrasound in determining the malignant nature of a nodule?

A

Composition
Echogenicity
Margination
Calcification

32
Q

What aspect of composition is associated with higher risk of malignancy?

A

The solid component

33
Q

How do the margins appear in malignant lesions?

A

The regular or poorly defined margins

34
Q

Which calcifications are indicative of a malignancy?

A

Fine and punctate

35
Q

What are the features associated with thyroid cancer?

A 
Microcalcifications
Solid hypoechogenicity
Irregular margins
Absence of halo
Intranodule central vascularity
More tall than wide
36
Q

Which conditions cause diffuse thyroid disease?

A

Chronic autoimmune thyroiditis (Hashimoto’s)
Adenomatous goiter
Graves’ disease

37
Q

How does Hashimoto’s thyroiditis appear on ultrasound?

A

Hypoechoic diffuse enlargement with a coarse parenchymal echotexture

38
Q

What is a goiter?

A

Enlarged thyroid gland that may be diffuse or nodular

39
Q

How is thyroid function in different types of goiters?

A

Normal – nontoxic goiter
Overactive – toxic goiter
Underactive – hypothyroid goiter

40
Q

What is the most common cause of a goiter worldwide?

A

Iodine deficiency

41
Q

How do goiters appears sonographically?

A

Multiple discrete nodules
Diffuse parenchymal inhomogeneity
Mixed echogenicity without normal tissue

42
Q

What is Graves disease?

A

Autoimmune disorder characterized by hyperthyroidism due to circulating antibodies

43
Q

How does Graves disease cause hyperthyroidism?

A

Thyroid antibodies bind to activate thyrotropin receptors causing the thyroid gland to grow causing an increased production of thyroid hormones

44
Q

How does the thyroid appear on ultrasound in Graves’ disease?

A

Diffusely hypoechoic and inhomogeneous

45
Q

How does a parathyroid adenoma appear on ultrasound?

A

Oval hypoechoic mass posterior to the thyroid gland

46
Q

What is the most common type of hyperparathyroidism?

A

Development of an adenoma associated with one of the parathyroid glands

47
Q

How is primary hyperparathyroidism diagnosed?

A

Increased serum parathyroid hormone with increased serum calcium

48
Q

Which condition develops secondary hyperparathyroidism?

A

Chronic renal failure because of increased amounts of serum phosphates

49
Q

What stimulates parathyroid gland hyperplasia in secondary hyperparathyroidism?

A

Inability to synthesize vitamin D depresses the serum calcium level

50
Q

What is the most common manifestation of multiple endocrine neoplasia, type 1?

A

Hyperparathyroidism resulting in hyperplasia of all four parathyroid glands

51
Q

What are the salivary glands?

A

Exocrine glands that secrete saliva and amylase

52
Q

Where are the sublingual glands located?

A

Beneath the tongue, anterior to submandibular glands

53
Q

Where are the parotid glands located?

A

Anterior to the ear wrapped around the mandibular ramus

54
Q

Where are the submandibular glands located?

A

Beneath the jaw

55
Q

Name the salivary glands.

A

Parotid
Sublingual
Submandibular

56
Q

Which ducts are associated with each salivary gland?

A

Parotid - Stensen’s duct

Submandibular - Wharton’s duct

57
Q

What are the diseases of the salivary glands?

A 
Mumps
Sjögren's syndrome
Mucoceles
Neoplasms
Salivary duct calculus
58
Q

What is the most common superficial midline neck mass in adolescents with an associated URI?

A

Thyroglossal duct cyst

59
Q

What is a thyroglossal duct cyst?

A

Cystic dilatation of the thyroglossal duct which is a remnant of the thyroid gland migration from the pharyngeal epithelium

60
Q

What is a branchial cleft cyst?

A

Solitary, predominantly cystic mass appearing on the lateral aspect of the neck at the angle of the mandible under the SCM

61
Q

What is a cystic hygroma?

A

Congenital lymphatic malformation

75% occur in neck

62
Q

How does a cystic hygroma appear on ultrasound?

A

Cystic multiloculated cervical mass that is evident at birth

63
Q

What syndromes are associated with a cystic hygroma?

A

Turner syndrome
Down syndrome
Klinefelter syndrome
Trisomy 18 and 13

64
Q

What are the vessels of the aortic arch?

A

Innominate artery
Left common carotid artery
Left subclavian artery

65
Q

Is there a left innominate artery?

A

NO - only one innominate artery but bilateral innominate veins

66
Q

At what level does the common carotid artery bifurcate?

A

Superior border of the thyroid cartilage

67
Q

Where are the ICA and ECA located?

A

ICA – lateral and posterior

ECA – medial and anterior

68
Q

Describe the waveforms of the ICA and ECA.

A

ICA – low resistance

ECA – high resistance

69
Q

What is the first branch of the ICA and the ECA?

A

ICA – ophthalmic artery

ECA – superior thyroid artery

70
Q

Where is the internal jugular vein in relation to the common carotid artery?

A

Lateral

71
Q

What do the internal jugular vein and subclavian vein drain into?

A

The innominate or brachiocephalic veins bilaterally

Abdominal Sonography (12 decks)

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