Thyroid/Neck/Vessels Flashcards
The thyroid gland has ___ lobes that are situated on eitehr side of the _____.
2
trachea
What is a normal thyroid variant that extends from sueprior from the isthmus?
pyramidal lobe
NML thy parenchyma has a _____ level homogeneous echotexture and appears _____ compared to the anterior strap muscles.
medium
hyperechoic
Where are the sternoclastoid muscles located to the thyroid?
anterolaterally
Sonolucent bands along the anterior surface of the thyroid gland?
strap muscles (sternohyoid, sternothroid, omohyoid)
What vessel is directly lateral to the thyroid gland?
common carotid artery
What vessel is directly lateral to the CCA?
internal jugular vein
What msucles are posterior to the thyroid gland?
longus-colli muscles seen as a wedge-shaped sonolucent structure adjacent to the cervical vertebrare
What is the minor neurovascular bundle and where is it located?
composed of the recurrent laryngeal nerve and inferior thyroid vessels
seen as a vague hypoechoic area between the longus colli muscle and thyroid gland
Parathyroid glands are typically not seen unless abnormal, where are they located?
posetrior aspect of the thyroid
The trachea gives a charcateristic refecting surface that creates what artifact?
reververation artifact
The esophagus is usually hidden by the trachea but can seen as a ______ sign in TRV.
target
ask patient to swallow to identify
Where does the thyroid arterial supply come from?
superior thyroid arteries (branches from ECA)
inferior thyroid arteries (branches from thyrocervical trunk)
Describe the venous vasculature for the thyroid
drained into the IJV via the superior and middle thyroid veins. then into the innominate veins via the inferior thyroid veins
What do thyroid hormones control?
meatbolism* growth body temp muscle strength appetite health of heart, brain, kidney, reproductive system
Thyroid cells are the only cells in the body that absorb____.
iodine
What glands regulate thyroid hormones?
Thyroid (T3/T4)
Pituitary (TSH)
Hypothalamus (TRH, thyrotropin-releasing hormone)
TSH
produced by the pituitary
stimuates thyroid hormone production
First indication of the hypothyroidism?
increased TSH (NML 0.3-3.0)
-serum THY hormones:
T4 - tetraiodothyronine (thyroxine)
T3 - triiodothyronine
What regulates the pituitary gland?
hypothalamus
Graves and TSH
Hyper
low TSH
elev T4/T3
Hashis and TSH
Hypo
elev TSH
low T4/T3
Benign Dx assoc with nodular thy disease
colloid nodules degenerative cysts hyperplasia thyroiditis benign neopasms
Thyroid adenomas are ______ neoplasms, which are usually classified as ______ or _____.
benign
follicular
papillary
What is the most common type of adenoma?
follicular adenomas
LEast common type of thyroid adenoma?
papillary adenomas
Characteristics of follicular adenomas
homogeneous
solitary
encapsulated
further classified according to their cellular architecture (fetal, colloid, embryonal, Hurthle cell types)
Cystic lesions are common in thyroids, they may be simple or they can contain a bright echogenic foci, which typically represent ______-_____ cysts.
Colloid-filled cysts
Most common primary thyroid carcinoma?
papillary carcinoma, accounts for 75-80% of all cases
Sono appearance of papillary thyroid carcinoma?
hypoechoic mass with possible calcifications
T/F The presence of nodual metastasis of papillary carcinoma does not adversely alter the prognosis.
T
Patient with nonpalpable papillary carcinoma may repsent with enlarged ______ _______ ______.
cervical lymph nodes
Follicular carcinomas account for ______ - ______% of thyroid cancers.
10-20%
What are similar in appearance to follicular carcinomas, which are encapsulated?
benign follicular adenomas, may be indistinguishable
Follicular thyroid cancers tend to spread through the _____ rather than the lymphatics. Metastasis to the ____ and ______- is more likely than cervical lymph nodes.
blood
lung and bone
Medullary carcinomas account for ____% of all thyroid carcinomas.
5%
Medullary thyroid carcinomas secrete ______, which can be a useful serum marker.
calcitonin
Medullary thyroid carcinoma is associated with ______ ____ ________ syndrome.
multiple endocrine neoplasia syndrome
Groups with a higher prevalence for thyroid cancer:
hx of head and neck irradiation family hx of: multiple endocrine neoplasia II familial adenomatous polyposis Gardner's syndrome Cowden's disease
FNA should be considered in a nodule
>1.0cm w/ microcalcifications >1.5cm predominantly solid >2.0cm mixed components if it demonstrates growth if ipsilateral abnormal lymph nodes (>7mm in short axis)
In particular, a predominantly ______thyroid nodule with ________ has a ______% likelihood of being a cancer
solid
microcalcifications
31.6%
What is the recommended minimal size of a soild nodule for FNA?
1.0cm
Are thyroid cancers usually hypoechoic or hyperechoic?
hypoechoic
Benign thyroid nodules tend to have _____, ________ margins.
sharp, well-defined
Malignant thyroid nodules tend to have ____ or _____ defined margins.
irregular, poorly
When it comes to calcifications, the most reliable feature of a benign thyroid nodule is ______ or _______ callcifications.
peripheral or eggshell calcification
Factors used to determine the malignant nature of a thyroid nodule
composition
echogenicity
margination
calcification
Features associated with thyroid cancer
microcalcifications solid hypoechogenicity irregular margins absence of halo intranodule central vascularity nodule more tall than wide
Calcifications that are ____ and _____ are more suggestive of a malignancy.
fine and punctate
Diffuse thyroid disease results in
generalized enlargement of the gland (goiter)
How is diffuse thyroid disease Dx?
usually made on the basis of clinical and laboratory findings, and FNA
Worldwide, what is the most common casue of a goiter?
iodine deficiency
Conditions that commonly produce diffuse enlargement of the thyroid (3)
chronic lymphocytic thyroiditis (Hashimoto’s)
Multinodular goiter
Grave’s Disease
What are the 5 types of thyroiditis?
Hashis subacute granulomatous subacute lymphocytic acute suppurative riedel struma
What is the most common type of thyroiditis and goiter in the US?
chronic lymphocytic thyroiditis (Hashimoto’s)
Autoimmune condition in which there is destruction of the thyroid gland by the immune system
chronic lymphocytic thyroiditis (Hashimoto’s)
What happens as the gland bceomes more damaged in the setting of Hashimoto’s?
gland is less able to make adequate supplies of thyroid hormone
the pituitary senses low thyroid hormone levels and secretes more TSH to stimulate the thyroid, which causes the gland to grow
-TSH elevated and T4/T3 decreased
Common cause of chronic lymphocytic thyroiditis (Hashimoto’s)
hypothyroidism
Sonographic appearance of chronic lymphocytic thyroiditis
hypoechoic
diffuse enlargement
coarse parenchyma
multinodular goiter (MNG)
enlargement of the thyroid gland or have multiple nodules that leads to enlargement of the whole gland
What are the 2 forms of MNG?
Nontoxic MNG (goiter makes normal amounts of thyroid hormone) Toxic MNG (goiter makes higher than normal amounts of thyroid hormone leading to a suppressed TSH
What is a multinodylar goiter, MNG?
enlargement of the thyroid gland either it is generallly enlarged or there are multiple nodules that enlarge the whole thyroid
Most common cause of hyperthyroidism?
Grave’s disease
Autoimmune disorder where the immune system produces a protein, thyroid stimulating immunoglobulin (TSI), which stimulates the thyroid to enlarge into a goiter and stimulates gand to make too much thyroid hormone, causing hyperthyroidism. The pituitary senses to much thyroid hormone and stops secreting TSH
Grave’s Disease
low TSH
elevated T4/T3
Symptoms of Grave’s disease?
diffusely enlarged thyroid (goiter) opthalmopathy-prominent eyes (hallmark sign) tachycardia tremors, muscle weakness papitations, dyspnea on exertion weight loss
What snographic finding is strongly associated with Grave’s disease?
hypervascularity, thyroid inferno
could be an audible bruit, palpable thrill
Will also appear diffusely hypoechoic and inhomogeneous
There are ______ parathyroid glands located ______ to the thyroid gland.
4
posterior
-can be located ectopic locations (retrotracheal, mediastinal, intrathyroid or near the carotid bifurcation)
T/F the minor neurovascular bundle may be mistaken for an enlarged parathyroid gland?
T
SOnographic appearance of a parathyroid adenoma
oval hypoechoic mass posterior to the thyroid gland
Most common type of hyperparathyroidism
Primary Hyperparathyroidism
Primary Hyperparathyroidism is due to the development of an _______ associated with one of the parathyroid glands
adenoma (Parathyroid adenoma)
HOw is the diagnosis of Primary Hyperparathyroidism (parathyroid adenoma) established?
If serum calcium level is elevated, which increases serum parathyroid hormone (PTH)
-surgical excision is teh treatment
What neck pathology is associated with chronic renal failure?
secondary hyperparathyroidism
In patient with chronic renal failure, the inability of the kidneys to filter results in______ amounts of serum _________.
increased
phosphates
(GFR <25%)
With secondary hyperparathyroidism, the inability to synthesize Vit ____ depresses the serum calcium level, which stimulates parathyroid gland ______.
vit D
hyperplasia
With secondary hyperparathyroidism, ______ of the parathyroid glands enlarges.
4
Secondar y hyperparathyroidism results in
bone demineralization
calcification of soft tissue and vascular structures
Hyperparathyroidism is the most common manifesttaion of ______ ________ _______, type I, which results in hyeprplasia of all fouru parathyroid glands
multiple endocrine neoplasia (MEN Type 1)
exocirne glands that secrete saliva and the enzyme amylase
salivary glands
What are the three types of salivary glands
Parotid
Submandibular
sublingual
Parotid is located _____ to the ear at the angle of the mandible adjacent to the masseter msucle.
anterior
What duct drains the parotid gland into the oral cavity?
Stensen’s duct
Most common benign tumor of the parotid gland
plemorphic adenoma
bacterial infection of a salivary gland, usually from a stone obstruction or gland hyposecretion
Sialadenitis
most common in the parotid and typically occurs in patients with zerostomia, Sjoren syndrome or radiation therapy
Gland located benath the jaw within level I of the neck
submandibular glands
Secretions from this gland enter the oral cavity through Wharton’s ducts
submandibular glands
________ condition most common within the submandibular gland where a calcified mass or sialolith forms within the salivary gland, usually in the duct of the submandibular gland
sialolithiasis
Where are the sublingual glands located
beneathe the tongue, anterior to the submandibular glands
Most common superficial ML neck mass
thyroglossal duct cyst
What age group is associated with thyroglossal duct cyst
adolescents typically
sonographic appearance of thyroglossal duct cysts
cytsic dilatation of the thyroglossal duct (remnant of the thyroid gland migration from the pharyngeal epithelium)
Are upper respiratory infections assocated with thyroglossal cysts?
y
How does a branchial cleft cysts present?
solitary, predominantly cystic mass appearing on the lateral aspect of the neck at the angle of the andible under the sternoclastoid muscle
The branchial cysts is a remnant of what?
embryoninc development
What can happen if a branchial cleft cysts is connected to the mouth?
can become infected
Cystic hygromas aka
cystic lymphangioma
congenital lymphatic malformation
cystic hygroma
Where are cystic hygromas found?
75% occur in th eneck but can cocur throughout the body and is evidenced at birth
Sonographic appearance of a cystic hygroma
cystic multiloculated cervical mass evidenced at birth
Cystic hygromas are associated with
Turner Syndrome - females born with only 1 X chromosome, short staure, infertility, heart defects
Trisomy 21 - Down’s
XXY - Klinefelter Syndrome - genetic error after conception so not inherited, where males have an extra copy of the X chromosome, devlop breasts, little fascial, possibly no sperm production
Trisomy 18 - low birth wt, clenched hands, abn head shape, Edward’s
Trisomy 13 - multiple physical and mental defects, may not live past 1st week
What are the vessels of the aortic arch?
innominant (brachiocephalic trunk)
left common carotid artery
left subclavian
What does the brachiocephalic trunk divide into?
right common carotid artery
right subclavian
Which vessels in the neck do not originate from the aortic arch?
right common carotid artery
right subclavian
What is the relationship in location of the common carotid arteries and internal jugular vein as they ascend in the neck
the CCA are medial to the IJV
how many innominate arteries and veins are there Rt to LT.
Only one innominant artery on the right but the innominant veins are bilateral
At what level does the common carotid artery bifurcate into the internal carotid artery and external carotid artery
at the level of the superior border of the thyroid cartilage
Typically the ICA is ______ and _______ and the ECA is ______ and ______ in location.
lateral and posterior
medial and anterior
What kind of waveform does the ICA typically have?
low-resistance
What kind fo waveform does the ECA typically have?
high-resistance
What can happen to the ECA if there is a stenosis in the ICA?
The ECA may collateralize resulting in a low resistance waveform
What is the first branch of the ICA
opthalmic artery
What is the first branch of the ECA
superior thyroid artery
The internal jugular vein is located ______ to the common carotid artery
lateral
Where does the internal jugular vein and subcalvian veins drain into
innominant (brachiocephalic) veins
The external jugular vein is located _______ on the ______ aspect of the neck
suepriorly
lateral
