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Superficial Structures > Neck > Flashcards

Neck Flashcards

1
Q

Role of sonography in evaluating the thyroid gland

A

evaluate size, shape, echogenicity, and vascularity

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2
Q

Role of sonography in evaluating the neck for pathology

A

evaluate pathology for sonographic appearance, mass location, size, and vascularity

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3
Q

thyroid gland

A

An organ in the endocrine system that maintains body metabolism, growth and development.

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4
Q

location of the thyroid gland

A

Anterior, lower neck, (anteroinferior) inferior to the thyroid cartilage (below the Adam’s apple), on either side of the midline

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5
Q

thyroid gland consists of what parts

A

right and left thyroid lobe, isthmus, and pyramidal lobe

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6
Q

location of right and left thyroid lobes

A

sit on either side of the trachea

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7
Q

isthmus

A

connects right and left lobes

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8
Q

pyramidal lobe

A

If present, arises from isthmus and tapers or extends superiorly, but is most commonly seen in pediatric patients because it atrophies with age

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9
Q

normal adult thyroid size

A

4 to 6 cm long x 2 to 3 cm AP x 1.5 to 2 cm wide

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10
Q

thyroid size varies with what

A

gender, age, and body surface area and lobes are normally relatively equal in size

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11
Q

More common method used to determine if thyroid is enlarged

A

thyroid volume

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12
Q

thyroid volume is used to assess:

A

need for surgery or to determine the iodine-131 dosage to treat thyrotoxicosis

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13
Q

thyroid volume formula

A

Length x Width x Height (thickness) x .52

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14
Q

arterial blood supply to thyroid

A

2 superior thyroid arteries and 2 inferior thyroid arteries

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15
Q

2 Superior Thyroid Arteries branch from

A

External Carotid Arteries and descend to upper poles of thyroid

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16
Q

2 Inferior Thyroid Arteries branch from

A

Subclavian Artery and ascend to lower poles.

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17
Q

venous drainage of thyroid

A

2 superior thyroid veins and 2 inferior thyroid veins

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18
Q

venous drainage of thyroid drains into

A

internal jugular veins and brachiocephalic veins

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19
Q

anatomy located anterior to thyroid

A

3 strap muscles: sternothyroid, omohyoid, sternohyoid; and the sternocleidomastoid muscles

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20
Q

sonographic appearance of strap muscles

A

thin, hypoechoic bands anterior to thyroid

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21
Q

sonographic appearance of sternocleidomastoid muscles

A

larger oval band anterolateral to gland

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22
Q

anatomy located lateral to thyroid lobes

A

Common Carotid Artery and Internal Jugular Vein

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23
Q

anatomy located posterior to thyroid

A

parathyroid glands and longus colli muscles

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24
Q

anatomy located medial to thyroid

A

larynx, trachea, esophagus

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25
Q

esophagus located where

A

Sits medial to the left thyroid lobe between the trachea and the thyroid

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26
Q

sonographic appearance of esophagus

A

target in transverse plane (if unsure, have patient swallow. Esophagus will exhibit a peristaltic movement)

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27
Q

3 thyroid hormones

A

T3 (triiodothyronine), T4 (thyroxine) and calcitonin

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28
Q

T3 and T4 function

A

Stimulate cell metabolism: T4 (thyroxine) (the body’s way of breaking down food to convert to energy)

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29
Q

Function of calcitonin

A

plays a small role in regulating blood calcium levels

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30
Q

A low concentration of what hormones in the body causes a low BASAL METABOLIC RATE

A

thyroid hormones (T3 & T4)

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31
Q

A low basal metabolic rate in the body signals what

A

the hypothalamus that the body needs thyroid hormones

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32
Q

Hypothalamus secretes what hormone to tell the pituitary that the body needs thyroid hormones

A

thyrotropin regulating hormone (TRH)

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33
Q

Pituitary gland produces what hormone

A

thyrotropin, also known as TSH (thyroid stimulating hormone)

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34
Q

TSH causes what

A

the thyroid to release T3 and T4

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35
Q

High T4 and T3 indicates

A

hyperthyroidism

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36
Q

Low T4 and T3 indicates

A

hypothyroidism

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37
Q

low TSH with high T4 and T# indicates

A

hyperthyroidism

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38
Q

low TSH with low T4 and T# indicates

A

hypothyroidism

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39
Q

euthyroid

A

Normal thyroid function. The thyroid produces correct amount of thyroid hormone

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40
Q

primary thyroid dysfunction

A

Inherent dysfunction of thyroid gland itself

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41
Q

secondary thyroid dysfunction

A

Failure of pituitary gland or hypothalamus to properly signal the thyroid gland or dysfunction of pituitary or hypothalamus due to mass

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42
Q

most common thyroid disorder

A

hypothyroidism

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43
Q

hypothyroidism also known as

A

Myxedema

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44
Q

define hypothyroidism

A

Thyroid is not producing enough thyroid hormones (T3 & T4); under-secretion

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45
Q

most common cause of hypothyroidism

A

Hashimoto’s Thyroiditis, a chronic inflammatory

process caused by an autoimmune response that destroys thyroid cells

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46
Q

other causes of hypothyroidism

A

Low intake of iodine (goiter), Inability of thyroid to produce proper amount of thyroid hormone, Problem in pituitary gland

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47
Q

clinical signs and symptoms of hypothyroidism

A
  • Weight gain
  • Hair loss
  • Increased subcutaneous tissue around eyes
  • Lethargy
  • Intellectual and motor slowing
  • Cold intolerance
  • Constipation
  • Deep husky voice.
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48
Q

medical treatment for hypothyroidism

A

Synthetic thyroid hormones can treat, manage and

reverse symptoms. If left untreated, could lead to coma

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49
Q

extreme form of hyperthyroidism

A

Thyrotoxicosis

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50
Q

define hyperthyroidism

A

Production of too much thyroid hormones; oversecretion

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51
Q

causes of hyperthyroidism

A
  • Entire gland is out of control
  • Localized neoplasm (such as adenoma) causes overproduction of thyroid hormones
  • Grave’s Disease
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52
Q

clinical signs and symptoms of hyperthyroidism

A
  • Hyperthyroidism dramatically increases metabolic rate
  • Weight loss
  • Increased appetite
  • High degree of nervous energy
  • Tremor
  • Excessive sweating
  • Heat intolerance
  • Palpitations
  • Impaired fertility
  • Exophthalmos (protruding eyes).
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53
Q

2 nuclear medicine tests are performed together to determine thyroid function:

A
  • Iodine Uptake Scan

* Thyroid Scan

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54
Q

iodine uptake scan

A

Amount of radioactivity accumulated in the thyroid gland is measured at multiple time points for up to 24 hours

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55
Q

HIGHER % of radioactivity in thyroid gland than normal on iodine uptake scan indicates

A

hyperthyroidism

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56
Q

LOWER % of radioactivity in thyroid gland than normal on iodine uptake scan indicates

A

hypothyroidism

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57
Q

thyroid scan (nuc med) detects what

A

Detects the amount of radioactive tracer and uses it to create an image of the thyroid gland, showing the thyroid size, shape, and position

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58
Q

define hot nodule on nuc med thyroid scan

A

(hyper-functioning) concentrated spots of radioactivity. Considered to be benign

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59
Q

define cold nodule on nuc med thyroid scan

A

(nonfunctioning) areas with a lower concentration of radioactivity. More commonly seen. Have the potential to be malignant

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60
Q

before any ultrasound you should

A
  • Review exam indication/diagnosis (on physician’s order)
  • Review any available prior imaging
  • Take a thorough patient clinical history
  • Explain the examination procedure
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61
Q

clinical history prior to an starting the ultrasound exam should include

A
  • Results of physicians examination (Is there a palpable mass?)
  • Pain? If so, how long?
  • History of hyperthyroidism or hypothyroidism?
  • Symptoms related to hyper/hypothyroidism?
  • Currently taking thyroid medication? If so, how long?
  • History of any thyroid biopsy or surgery?
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62
Q

proper positioning for thyroid ultrasound

A

Supine position with pillow under both shoulders
• Neck extended with chin pointed toward ceiling
• When scanning each lobe sagittally, patient can slightly
turn face to opposite side (extending the neck on the side you are scanning). NOTE: this position causes dizziness once the patient sits up

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63
Q

transducer for thyroid ultrasound

A

High-frequency (7.5- to 15-MHz) linear-array

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64
Q

thyroid ultrasound should include what images?

A
  • Each lobe of the thyroid in LONGITUDINAL and TRANSVERSE (lateral to medial and superior to inferior)
  • Isthmus
  • Survey of the area superior, inferior and lateral to document any enlarged cervical lymph nodes
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65
Q

normal sonographic appearance of thyroid

A
  • Homogeneous texture

* Slightly more echogenic than the surrounding muscle

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66
Q

sonographic appearance of thyroid capsule

A

thin, hyperechoic line outlining the gland

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67
Q

sonographic appearance of trachea

A

curved structure with shadowing in the midline

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68
Q

transverse images to obtain of each thyroid lobe

A
  • Superior
  • Mid (with width measurement across the widest portion of the thyroid)
  • Inferior
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69
Q

longitudinal images to obtain of each thyroid lobe

A

Align the transducer with the Common Carotid Artery, then begin to move medially.
• Lateral
• Mid (with length and height measurement)
• Medial

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70
Q

images to obtain of pathology

A
  • Long (annotated with location: LONG RT THYROID LAT)
  • Trans (annotated with location: TRANS RT THYROID SUP)
  • Measurements in 3 planes
  • Color
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71
Q

aplasia

A

Congenital absence (can be uni- or bilateral)

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72
Q

hypoplasia

A

Underdevelopment of any part of the gland

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73
Q

most common locations of ectopic thyroid

A
  • Posterior to the tongue (sublingual) - most common location
  • Other locations: near larynx or mediastinum
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74
Q

best imaging modality to view ectopic thyroid

A

scintigraphy

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75
Q

most common thyroid abnormality

A

goiter

76
Q

goiter also known as

A

Nodular Thyroid Disease

77
Q

goiters are more common in whom

A

women with increasing age

78
Q

goiter caused by

A

Iodine deficiency is most common cause worldwide

79
Q

2 types of goiter

A

goiter and multi-nodular goiter

80
Q

define goiter

A

Overall enlargement

81
Q

define multinodular goiter

A

Overall enlargement due to multiple nodules

82
Q

define toxic goiter

A

Nodular enlargement that causes HYPERthyroidism

83
Q

define nontoxic goiter

A

Nodular enlargement that doesn’t cause thyroid dysfunction.

84
Q

clinical findings of goiter

A
  • Visible protrusion on the neck
  • Palpable enlarged thyroid
  • Difficulty swallowing (dysphagia) caused by compression of esophagus
  • Pressure on trachea
  • Globus sensation (feels like something is stuck in your throat when you swallow)
  • Clinical symptoms of hyperthyroidism or hypothyroidism
85
Q

sonographic appearance of goiter

A
  • Diffuse enlargement
  • Localized nodules
  • Appearance of nodules can vary
86
Q

thyroid cyst usually a result of

A

cystic degeneration of a follicular adenoma

87
Q

sonographic appearance of simple thyroid cyst

A

smooth walls, anechoic, posterior enhancement

88
Q

sonographic appearance of colloid cyst

A

cyst with tiny echogenic focus

89
Q

sonographic appearance of hemorrhagic cyst

A

low level echoes with possible fluid and debris, with possible internal septations

90
Q

thyroid adenoma benign or malignant

A

benign

91
Q

thyroid adenoma more common in whom

A

females

92
Q

thyroid adenoma solitary or multiple

A

often solitary

93
Q

thyroid adenoma slow or fast growing

A

usually slow growing

94
Q

if hemorrhage of thyroid adenoma occurs, what symptoms may happen

A

sudden, painful enlargement

95
Q

labs seen with thyroid adenoma

A

usually normal labs

96
Q

thyroid adenoma characterized by

A

complete fibrous encapsulation

97
Q

most common sonographic finding of thyroid adenoma

A

Thin, hypoechoic rim or halo (due to compressed tissue surrounding the adenoma

98
Q

sonographic findings of thyroid adenoma

A
  • MOST COMMON FINDING: Thin, hypoechoic rim or halo (due to compressed tissue surrounding the adenoma
  • Calcification around the rim with an “eggshell” appearance may be seen
  • Often homogeneous
  • Size: varies
  • Echogenicity: varies from anechoic to hyperechoic
99
Q

Higher risk of malignancy with ______ nodules

A

solitary

100
Q

Solitary nodule with ______ suggests malignancy.

A

cervical adenopathy on same side

101
Q

clinical findings common with malignancy of thyroid

A
  • Painless, palpable mass
  • Hard
  • Firm
  • Solitary
  • If more advanced: compression of adjacent structures causing: hoarseness, cough, or dysphagia
102
Q

sonographic appearance of thyroid malignancy

A
  • Any size, single or multiple.
  • Solid, partially cystic, or mostly cystic mass
  • Usually hypoechoic relative to normal thyroid
  • Calcifications are present in 50% to 80% of all types of thyroid carcinoma.
  • Increased vascularity may be present.
103
Q

MOST COMMON thyroid malignancy (70% of all thyroid cancers)

A

papillary thyroid carcinoma

104
Q

how aggressive is papillary thyroid carcinoma

A

least aggressive thyroid cancer

105
Q

prognosis of papillary thyroid carcinoma

A

excellent if caught early

106
Q

papillary thyroid carcinoma more common in whom

A

females age 20-40

107
Q

papillary thyroid carcinoma associated with patients with history of

A

upper chest and neck radiation

108
Q

papillary thyroid carcinoma usually metastasizes where

A

usually through lymphatics to nearby cervical lymph nodes

109
Q

sonographic findings of papillary thyroid carcinoma

A
  • Solid
  • Hypoechoic (when compared to nearby strap muscles)
  • Incomplete halo
  • Ill-defined margins
  • Microcalcifications that appear as tiny, punctate hyperechoic foci
  • Hypervascular
  • Ipsilateral Cervical lymph node metastasis (in approximately 20% of cases)
110
Q

2ND MOST COMMON type of thyroid cancer (10-20% of all thyroid cancers)

A

Follicular Thyroid carcinoma

111
Q

how aggressive is Follicular Thyroid carcinoma

A

more aggressive than papillary carcinoma

112
Q

Follicular Thyroid carcinoma prognosis

A

worse than papillary carcinoma

113
Q

Follicular Thyroid carcinoma more common in whom

A

females age 40-60

114
Q

Follicular Thyroid carcinoma not associated with

A

upper chest and neck radiation

115
Q

Follicular Thyroid carcinoma metastasizes where

A

through the bloodstream to bone, lung, brain and liver

116
Q

sonographic appearance of follicular thyroid carcinoma

A
  • Similar to a benign adenoma
  • Irregular margins
  • Thick irregular halo
  • Tortuous internal blood vessels
117
Q

medullary thyroid carcinoma slightly more common in whom

A

females

118
Q

thyroid carcinoma that may be familial

A

medullary thyroid carcinoma

119
Q

medullary thyroid carcinoma associated with

A

MEN 2 syndrome

120
Q

medullary thyroid carcinoma metastasizes where

A

High incidence of mets to cervical lymph nodes

121
Q

clinical findings of medullary thyroid carcinoma

A

Elevated calcitonin levels

122
Q

sonographic findings of medullary thyroid carcinoma

A
  • Solid hypoechoic mass with calcifications (similar to papillary carcinoma)
  • Hypervascularity
  • Cervical lymph node metastasis in advanced cases
123
Q

anaplastic thyroid carcinoma is considered undifferentiated because

A

because it can be associated with papillary or follicular carcinomas

124
Q

rare and most deadly thyroid cancer

A

anaplastic thyroid carcinoma

125
Q

anaplastic thyroid carcinoma twice as common in whom

A

men, usually after age 60

126
Q

50% of patients with anaplastic thyroid carcinoma have _____ mets

A

lung

127
Q

90% of patients with anaplastic thyroid carcinoma have _____ mets

A

cervical lymph node

128
Q

clinical findings common with anaplastic thyroid carcinoma

A
  • Rapidly growing
  • Hard, fixed mass
  • Dyspnea: difficulty breathing
  • Dysphagia: difficulty swallowing
  • Hoarseness
  • Cough
  • Rapid growth, with invasion into surrounding neck structures and widespread mets, usually causing death by compression/asphyxiation
129
Q

sonographic appearance of anaplastic thyroid carcinoma

A

• Large, hypoechoic mass, with invasion of surrounding structures

130
Q

thyroiditis

A

Group of disorders that include inflammation of the thyroid with several causes (bacterial/viral infection, postpartum, post-radiation, drug induced, or autoimmune

131
Q

all thyroiditis forms result in

A

hypothyroidism

132
Q

3 types of thyroiditis

A
  • Acute suppurative thyroiditis
  • Subacute granulomatous thyroiditis (de Quervain’s disease)
  • Chronic lymphocytic thyroiditis (Hashimoto’s disease)
133
Q

cause of subacute De Quervain’s thyroiditis

A

Viral infection of thyroid

134
Q

clinical findings of subacute De Quervain’s thyroiditis

A
  • Inflammation of thyroid
  • Dysphagia
  • Fever
  • Pain
  • Tenderness
  • Enlargement of thyroid
  • Malaise
135
Q

sonographic appearance of subacute De Quervain’s thyroiditis

A

may appear enlarged and hypoechoic

136
Q

subacute De Quervain’s thyroiditis may cause

A

transient hyperthyroidism, but in period of weeks or months swelling and pain subside and gland functions normally

137
Q

most common form of thyroiditis

A

Hashimoto’s Thyroiditis

138
Q

Hashimoto’s Thyroiditis

A

Destructive autoimmune disorder that leads to chronic inflammation of thyroid

139
Q

clinical findings of Hashimoto’s Thyroiditis

A
  • Painless
  • Enlarged thyroid gland
  • Most often in young to middle-aged women
  • Entire gland is involved but enlargement is NOT always symmetric
  • Hypothyroidism
140
Q

sonographic findings of Hashimoto’s Thyroiditis

A
  • Heterogeneous thyroid
  • Enlarged
  • Micronodulation with ill-defined hypoechoic areas
  • Color Doppler shows normal to decreased flow velocity
  • “Thyroid inferno” seen once hypothyroidism develops.
  • Cervical lymphadenopathy
141
Q

Most common cause of hyperthyroidism

A

Graves’ Disease

142
Q

Graves’ Disease

A

Autoimmune disease where immune system attacks thyroid and causes it to produce thyroid hormones

143
Q

clinical findings of Graves’ Disease

A
  • Characterized by a triad:
  • Hypermetabolism
  • Diffuse toxic goiter
  • Exophthalmos (bulging eyes)
144
Q

sonographic findings of Graves’ Disease

A
  • May appear normal or
  • May appear as an enlarged, heterogeneous (inhomogeneous) than a simple goiter
  • Increased vascularity on color Doppler imaging, leading to term “thyroid inferno”
145
Q

parathyroid glands

A

Paired endocrine organs; Calcium sensing organs

146
Q

most people have how many parathyroid glands

A

four

147
Q

parathyroid glands lie where

A

Two lie posterior to each superior pole of thyroid; two lie posterior to each inferior pole

148
Q

parathyroid glands shape

A

Small, flat and disc-shaped

149
Q

sonographic appearance of parathyroid glands

A
  • Enlarged glands (>5 mm):
  • Hypoechoic
  • Elongated mass between posterior longus colli and anterior thyroid lobe
150
Q

Normal-size glands (<4 mm) are usually not seen with sonography, often parathyroids are first evaluated with ________

A

Nuclear Medicine

151
Q

function of parathyroid glands

A

Produce parathyroid hormone (PTH) and monitor serum calcium feedback mechanism

152
Q

parathyroid hormone acts on what

A

PTH acts on bone, kidney, and intestines to increase calcium absorption into the blood

153
Q

clinical history prior to an starting the ultrasound exam to evaluate parathyroid glands should include

A
  • Previous diagnosis of parathyroid disease?
  • History of: kidney stones, ulcers, pancreatitis or osteoporosis?
  • History of: chronic renal failure or dialysis? (these could explain abnormal lab values due to secondary hyperparathyroidism)
  • Recent serum calcium levels and PTH levels?
154
Q

proper positioning for parathyroid ultrasound

A
  • Supine position with pillow under both shoulders
  • Neck extended with chin pointed toward ceiling
  • Upper neck (jaw to sternal notch) evaluated, transverse and longitudinal planes of thyroid/parathyroid area
155
Q

transducer for parathyroid ultrasound

A

High-frequency (7.5- to 15-MHz) linear-array

156
Q

Primary hyperparathyroidism

A

Increased function of parathyroid glands

157
Q

Primary hyperparathyroidism more common in whom

A
  • More common after age 40

* More common in women, particularly after menopause

158
Q

Primary hyperparathyroidism characterized by

A

Abnormal secretion of PTH, which signals more calcium to be secreted in the blood

159
Q

Primary hyperparathyroidism lab findings

A
  • Hypercalcemia
  • Hypercalciuria
  • Low serum levels of phosphate (hypophosphatemia)
160
Q

Primary hyperparathyroidism symptoms

A

Usually asymptomatic

161
Q

role of sonography in evaluating Primary hyperparathyroidism

A
  • Determine if a mass is present or if parathyroid hyperplasia is present
  • Mass could represent: parathyroid adenoma or parathyroid carcinoma
162
Q

Secondary hyperparathyroidism

A

Occurs when PTH level is increased due to chronic hypocalcemia which is caused by renal failure, vitamin D deficiency (rickets), or malabsorption syndromes

163
Q

Secondary hyperparathyroidism lab values

A

Elevated PTH level and low calcium levels

164
Q

parathyroid hyperplasia

A

Hyperfunction of all parathyroid glands with no apparent cause

165
Q

Hyperplasia usually involves _____ glands

A

all 4

166
Q

Most common cause of primary hyperparathyroidism (80% of cases)

A

parathyroid adenoma

167
Q

parathyroid adenoma benign or malignant

A

benign

168
Q

parathyroid adenoma solitary or multiple

A

Usually solitary, but can involve one or more of the four glands

169
Q

treatment for parathyroid adenoma

A

Surgical removal

170
Q

sonographic appearance of parathyroid adenoma

A
  • Oval
  • Hypoechoic
  • Homogeneous
  • Usually solid
  • Color doppler is usually peripheral (as opposed to hilar that is seen with lymph nodes)
171
Q

lab values with parathyroid carcinoma

A

Very high Serum Calcium levels

172
Q

clinical findings of parathyroid carcinoma

A

Small, irregular, firm masses

173
Q

sonographic findings of parathyroid carcinoma

A
  • Usually larger, more irregular in shape
  • Lobulated contour
  • May be taller than wide
174
Q

thyroglossal duct cyst

A

Remnant of the tubular development of thyroid gland may persist between base of tongue and hyoid bone leaving a narrow hollow tract that usually atrophies with age.

175
Q

Most common congenital cystic abnormality

A

thyroglossal duct cyst

176
Q

thyroglossal duct cyst located where

A

midline of neck anterior to trachea, between the hyoid bone and the isthmus of the thyroid

177
Q

thyroglossal duct cyst usually seen in whom

A

pediatric patients, younger than age 10

178
Q

sonographic findings of thyroglossal duct cyst

A
  • Characteristics of a cyst

* Oval or spherical masses rarely larger than 2 or 3 cm

179
Q

Congenital cystic mass seen lateral to thyroid gland, in submandibular region

A

branchial cleft cyst

180
Q

branchial cleft cyst seen in whom

A

Found more often in older children and young adults

181
Q

sonographic findings of branchial cleft cyst

A

• Primarily cystic, but may have complex or solid components with low level echoes

182
Q

clinical findings of abscess

A
  • Pain
  • Erythema
  • Edema
  • Fever
  • Palpable mass
183
Q

sonographic findings of abscess

A
  • Varies: ranges from fluid-filled to completely echogenic
  • Most commonly, mass of low-level echogenicity with irregular walls
  • May show the presence of air with ring down artifact
  • Chronic abscess may be particularly difficult to demonstrate because indistinct margins blend with surrounding tissue.
184
Q

adenopathy

A

Enlargement of lymph nodes

185
Q

lymph nodes can become enlarged due to

A

hyperplasia, metastasis or inflammatory process

186
Q

sonographic findings of lymphadenopathy

A
  • More rounded shape than normal lymph node
  • Loss of echogenic hilum
  • Lobular contour

Superficial Structures (3 decks)

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