Parathyroid and Salivary glands Flashcards
How many pairs of parathyroid glands are typically located in the neck?
2 pairs
What is the relationship of the parathyroid glands to the thyroid glands? 2
- Most adults have two located superior posterior to the mid portion of the thyroid gland and two inferiors located in a slightly more variable position.
- The inferior parathyroid glands are located posterior or just inferior to the lower thyroid pole
What is the typical dimension and shape of a parathyroid gland?
1x3x5
What is the echogenicity of a normal parathyroid gland compared to the thyroid gland?
It is usually pretty hard to image the parathyroid because it is isoechoic to the thyroid
What is the main physiologic function of the parathyroid gland?
Production of parathyroid hormone, which has the most important endocrine regulator of calcium and phosphorous concentrations in extra cellular fluid
What is meant by a “False positive” parathyroid examination?
The test results suggest hyperparathyroidism or some other parathyroid disorder, but upon further analysis the individual does not actually have the condition
Name three structures that could create a “false positive” result during a parathyroid ultrasound?
- Esophagus
- Longus Coli
- Minor bundles
What is the most common cause of primary hyperparathyroidism?
Parathyroid edema
In primary hyperparathyroidism, indicate whether the substances below are increased or decreased serum levels?
- Calcium
- PTH
Both are increased
What is the most definitive treatment for hyperparathyroidism?
Surgery
What inherited disorder is strongly linked to parathyroid hyperplasia?
MEN type 1
(multiple endocrine neoplasia type 1)
What are the most common locations for ectopic superior and inferior adenomas? 2
- Most commonly found in the superior and inferior locations adjacent to the thyroid gland
- 3% of cases are found in the same ectopic locations as the parathyroid glands, which the low neck, mediastinum, reterotracheal/ retroesophageal, undescended/ carotid sheath, and intrathyroid gland
What are two causes of secondary hyperparathyroidism?
- Chronic renal insufficiency
- Vitamin D deficiency
What is the typical sonographic appearance of a parathyroid adenoma? 3
- Hypoechoic
- Homogenous solid masses
- Echogenicity is usually less than the thyroid gland and may be so hypoechoic as it simulates a cyst
What doppler patterns might assist you in differentiating a parathyroid adenoma from a lymph node? 3
- Hypervascular pattern with a prominent diastolic flow
- Peripheral vascular arc that may allow for differentiation from hyperplasiticity region lymph nodes, which has a similar hilar flow pattern
- Identify an extrathryoidal feeding artery supply the adenoma
What is the typical size and sonographic appearance of a parathyroid carcinoma? 4
- May demonstrate more attenuation than is typically seen with hyperplasia or adenomas
- lobular contour with a heterogenous internal structure and internal cystic components
- Similar to large benign adenomas or hyperplasia
- Typical size of a parathyroid carcinoma is more than 2 cm compared to average 1cm of adenomas
List the three pairs of salivary glands
- Parotid glands
- Submandibular glands
- Sublingual gland s
Identify the salivary gland in which each of the following ducts is located
Stensen’s duct
Wharton’s duct
Bartholins duct
- Partoid
- Submandibular
- Sublingual
Which salivary gland is located anterior to the ear and sternocleidomastoid muscle?
Parotid
Which salivary gland is located under the tongue?
Sublingual
Which salivary gland is located medial and oblique to the mandible?
Submandibular
What sonographic feature differentiates an intraparotid node from a parotid mass
Echogenic hilum
Which salivary gland is most affected by sialolithiasis?
Submandibular
Which salivary gland is typically affected by acute suppurative sialdenitis?
The parotid
What is the most common sonographic appearance of acute inflammation of the salivary glands?
Enlarged and hypoechoic
What is sialosis?
A non-inflammatory, non neoplasticism, recurrent, painless salivary gland swelling, usually bilateral, which most often concerns the parotid glands
What is the name of the autoimmune disease that occurs in middle aged females causing chronic inflammation?
Sjogrens syndrome
What is the most common patient presentation with a salivary gland tumor?
Palpable lump
Which salivary glands are most likely to present with a malignant neoplasm?
The smaller glands: the submandibular and sublingual
What is the most common benign parotid neoplasm?
Pleomorphic adenomas
Describe the most common sonographic features of the neoplasms of pleomorphic adenomas? 5
- Hypoechoic
- Well defined
- Lobulated tumors
- Homogenous
- Posterior enhancement
What is the name of the benign neoplasm that affects elderly men?
Warthin tumor
Describe the most common sonographic features of the neoplasm warthin? 6
- Oval
- Hypoechoic
- Well-defined
- Contains multiple anechoic areas
- Heterogenous
- Anechoic with through transmission
What are the two most common types of malignancy affect the salivary glands?
- Mucoepidemoid carcinomas
- Adenoid cystic carcinomas
What is the most common malignant neoplasm of the submandibular gland?
Adenoid cystic carcinoma
What are the most common sonographic features of adenoid cystic carcinomas? 4
- Irregular shape
- Irregular boarders with blurred margins
- Hypoechoic
- Can be homogenous or heterogenous
How does the patient presentation of malignant salivary neoplasms differ from that of bening neoplasms? 4
- Grow rapidly
- Maybe tender or painful and palpation
- Can be fixed to the background
- Can cause facial nerve paralysis or paresis
