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Li X, Zhang G, Li Y, Zhang X, Liu Q, Sun N, Liu Z, Hao J, Chen Z, Liu Y, Zhang J, Wang S, Ni X. Modified Sistrunk Procedure in 391 Pediatric Thyroglossal Duct Cyst Cases: Clinical Analysis of Efficacy and Recurrence Risk. EAR, NOSE & THROAT JOURNAL 2024:1455613241257353. [PMID: 38853413 DOI: 10.1177/01455613241257353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Objectives: The study aims to retrospectively summarize the clinical features of pediatric thyroglossal duct cyst (TGDC), investigate the efficacy of the modified Sistrunk (mSis) procedure, and analyze the recurrence risks. Methods: The clinical data of 391 children with TGDC admitted to Beijing Children's Hospital affiliated Capital Medical University and Baoding Children's Hospital from March 2012 to December 2021 were retrospectively analyzed. All patients underwent cervical ultrasound for preoperative evaluation. Twenty cases had magnetic resonance imaging and 8 cases had computed tomography for further evaluation. All patients underwent the standard mSis procedure, and clinical manifestations information, surgical information, complications, and prognosis were analyzed. Results: Among the 391 TGDC cases, 118 (30.2%) had a history of recurrent neck infection and 36 (9.2%) had undergone previous neck cyst and fistula resection surgeries, initially diagnosed as neck cyst (22 cases), TGDC (12 cases), or branchial fistula (2 cases), with only 6 cases having undergone partial hyoid bone resection in the previous operation. During the 15 to 156 months of follow-up, 10 children experienced local wound infection, but no other complications were reported. The recurrence rate was 2.30%, and the recurrence time ranged from 0.5 to 34 (average, 7.2) months post surgery. In the Poisson regression model examining factors related to recurrence, the P values of the 3 factors were <.05: clearness of the lesion boundary, surgical history, and maximum diameter and the relative risk (RR) values corresponding to the 3 risk factors, such as Exp (B), were 27.918, 10.054, and 6.606, respectively. Conclusions: The mSis procedure demonstrated safety and efficacy with fewer complications and a low recurrence rate of 2.30% in the study. Furthermore, the indistinct lesion boundary, surgical history, and large lesion diameter (>2 cm) were independent risk factors for recurrence in pediatric TGDC.Level of Evidence: IV.
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Affiliation(s)
- Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ge Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanzhen Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuexi Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qiaoyin Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Nian Sun
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhiyong Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jinsheng Hao
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Otolaryngology, Baoding Hospital of Beijing Children's Hospital, Baoding, China
| | - Ziwei Chen
- Department of Otolaryngology, Baoding Hospital of Beijing Children's Hospital, Baoding, China
| | - Yuwei Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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2
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Chung M, Ton L, Lee AY. Forget Me Not: Incidental Findings on Breast MRI. JOURNAL OF BREAST IMAGING 2024:wbae023. [PMID: 38758984 DOI: 10.1093/jbi/wbae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Indexed: 05/19/2024]
Abstract
With the growing utilization and expanding role of breast MRI, breast imaging radiologists may encounter an increasing number of incidental findings beyond the breast and axilla. Breast MRI encompasses a large area of anatomic coverage extending from the lower neck to the upper abdomen. While most incidental findings on breast MRI are benign, identifying metastatic disease can have a substantial impact on staging, prognosis, and treatment. Breast imaging radiologists should be familiar with common sites, MRI features, and breast cancer subtypes associated with metastatic disease to assist in differentiating malignant from benign findings. Furthermore, detection of malignancies of nonbreast origin as well as nonmalignant, but clinically relevant, incidental findings can significantly impact clinical management and patient outcomes. Breast imaging radiologists should consistently follow a comprehensive search pattern and employ techniques to improve the detection of these important incidental findings.
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Affiliation(s)
- Maggie Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Lauren Ton
- School of Medicine, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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3
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Chen J, Shen X, Lian M, Fang J. Parapharyngeal space ectopic thyroid with eutopic papillary thyroid cancer: A case report. Oral Oncol 2023; 146:106577. [PMID: 37783135 DOI: 10.1016/j.oraloncology.2023.106577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Ectopic thyroid is a rare condition. Here we report an extremely rare case of parapharyngeal space ectopic thyroid, which has simultaneously found the papillary thyroid carcinoma of the eutopic thyroid. CASE PRESENTATION A 54-year-old woman was admitted to our hospital for a thyroid tumor and neck lymph nodes. CT and MR imaging revealed the presence of a thyroid right node, as well as a right parapharyngeal mass with a diameter of 2.5 × 2.3 cm. PET-CT was also performed to diagnose further, revealing that the suv metric of the PPS mass was 4.03. Considering that the mass was asymptomatic, we did not handle it at the first thyroid surgery. However, when the patient underwent a radioactive iodine scan before the radioactive iodine treatment, the imaging showed that the mass could intake the iodine. So, we arranged the second surgery for this mass, and the postoperative pathological examination confirmed the mass was well-differentiated thyroid tissue. CONCLUSION Parapharyngeal ectopic thyroid with eutopic thyroid cancer is extremely rare. Preoperative imaging examination can significantly avoid the missed diagnosis of this disease. Surgical resection is recommended for the ectopic thyroid while the eutopic thyroid is found to be malignant.
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Affiliation(s)
- Jiaming Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xixi Shen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Meng Lian
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jugao Fang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Booth TN. Congenital Cystic Neck Masses. Neuroimaging Clin N Am 2023; 33:591-605. [PMID: 37741660 DOI: 10.1016/j.nic.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Congenital cystic masses are commonly encountered when imaging a patient presenting with a neck mass. Congenital cysts are present at birth; however, these cysts may not present until later in life with some growing slowly and others rapidly increasing in size due to hemorrhage of infection. A neonatal presentation is rare but when present may allow a narrower differential diagnosis. Imaging plays a significant role in defining a lesion as cystic, assessing location, and directing the next step in evaluation and or intervention.
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Affiliation(s)
- Timothy N Booth
- University of Texas Southwestern, Children's Health of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA.
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5
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Chiang JJY, Tan BWS, Chua AJK, Ong LY, Tan HKK. Surgical management of thyroglossal cysts: 10-year experience of a tertiary paediatric surgical unit. Singapore Med J 2023:386978. [PMID: 37929556 DOI: 10.4103/singaporemedj.smj-2019-111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Jayne Jie Yi Chiang
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | | | - Andy Jian Kai Chua
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
| | - Lin Yin Ong
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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6
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Rahim I, Napolitano A, Burd C, Lingam RK. Imaging of pharyngeal pathology. Br J Radiol 2023; 96:20230046. [PMID: 37334795 PMCID: PMC10461270 DOI: 10.1259/bjr.20230046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 06/21/2023] Open
Abstract
The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who present with pharynx-related symptoms such as sore throat, globus, dysphagia or dysphonia will usually undergo visual and nasal endoscopic examination in the first instance. Imaging is frequently required to supplement clinical assessment and this typically involves MRI and CT. However, fluoroscopy, ultrasound and radionuclide imaging are valuable in certain clinical situations. The aforementioned complexity of the pharynx and the myriad of pathologies which may arise within it often make radiological evaluation challenging. In this pictorial review, we aim to provide a brief overview of cross-sectional pharyngeal anatomy and present the radiological features of a variety of pharyngeal pathologies, both benign and malignant.
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Affiliation(s)
- Ishrat Rahim
- Specialty Registrar in Clinical Radiology, London North West University Hospitals NHS Trust, London, United Kingdom
| | - Angela Napolitano
- Consultant Neuroradiologist, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Chris Burd
- Consultant Radiologist, London North West University Hospitals NHS Trust, London, United Kingdom
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Kurokawa M, Kurokawa R, Tamura K, Baba A, Ota Y, Nakaya M, Yokoyama K, Kim J, Moritani T, Abe O. Imaging Features of Ectopic Tissues and Their Complications: Embryologic and Anatomic Approach. Radiographics 2023; 43:e220111. [PMID: 37141139 DOI: 10.1148/rg.220111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Ectopic tissue is an anatomic abnormality in which tissue develops in an area outside its normal location. It is primarily caused by abnormalities during the process of embryologic development. Although the majority of individuals with ectopic tissues remain asymptomatic, various symptoms and associated complications can occur. Failure in normal embryologic development leads to loss of normal physiologic function or may result in harmful functions such as ectopic hormonal secretion in the ectopic pituitary adenoma. Ectopic tissues may also frequently mimic tumors. For example, developmental abnormalities in the pharyngeal pouches may result in an ectopic parathyroid gland and ectopic thymus, both of which are frequently misdiagnosed as tumors. Adequate knowledge of embryology is essential for understanding the differential diagnoses of ectopic tissues and facilitating appropriate management. The authors summarize the embryologic development and pathogenesis of ectopic tissues by using illustrations to facilitate a deeper understanding of embryologic development and anatomy. Characteristic imaging findings (US, CT, MRI, and scintigraphy) are described for ectopic tissues of the brain, head, neck, thorax, abdomen, and pelvis by focusing on common conditions that radiologists may encounter in daily practice and their differential diagnoses. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Mariko Kurokawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - Ryo Kurokawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - Kentaro Tamura
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - Akira Baba
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - Yoshiaki Ota
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - Moto Nakaya
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - Kota Yokoyama
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - John Kim
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
| | - Osamu Abe
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (M.K., R.K., A.B., Y.O., J.K., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (M.K., R.K., M.N., O.A.); Department of Radiology, National Institutes for Quantum Science and Technology, Chiba, Japan (K.T.); and Department of Radiology and Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan (K.Y.)
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8
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Meng S. [Ultrasound of the neck]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:293-306. [PMID: 36881109 DOI: 10.1007/s00117-023-01131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
Ultrasound examination of the neck organs enables an assessment that in many cases is superior to that of magnetic resonance imaging and computed tomography. Ultrasound is therefore not only a first line or point of care imaging modality but can provide imaging for the concluding diagnosis in cases. Because of the good sonographic accessibility of the majority of the structures of the neck, many technical advances, in particular high-resolution ultrasound and signal post-processing have a major influence on the possibilities of ultrasound. Lymph nodes and salivary glands are the main focus in clinical applications, although other diseases and swellings of the neck can also be clarified with ultrasound. Special applications are ultrasound-guided interventions, e.g., biopsies or the sonographic assessment of peripheral nerves. As in any imaging modality, a comprehensive clinical knowledge is necessary for the diagnostic assessment. Because of constant assessment and thus continuous modification of the examination, ultrasound examinations may only be performed adequately with the appropriate clinical knowledge.
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Affiliation(s)
- Stefan Meng
- Radiologie, Hanusch-Krankenhaus, Heinrich-Collin-Straße 30, 1140, Wien, Österreich. .,Zentrum für Anatomie und Zellbiologie, Medizinische Universität Wien, Wien, Österreich.
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9
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Houas J, Ghammam M, Laabidi E, Bellakhdher M, Abdelkefi M. Ectopic Thyroid Tissue Presenting as a Lateral Neck Mass: A Case Report. Am J Med 2023; 136:e27-e28. [PMID: 36252713 DOI: 10.1016/j.amjmed.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Jihene Houas
- Department of Otorhinolaryngology-Head and Neck Surgery, Farhat Hached University Hospital, Sousse, Tunisia; Sousse Medical School, University of Sousse, Sousse, Tunisia.
| | - Monia Ghammam
- Department of Otorhinolaryngology-Head and Neck Surgery, Farhat Hached University Hospital, Sousse, Tunisia; Sousse Medical School, University of Sousse, Sousse, Tunisia
| | - Eya Laabidi
- Department of Otorhinolaryngology-Head and Neck Surgery, Farhat Hached University Hospital, Sousse, Tunisia; Sousse Medical School, University of Sousse, Sousse, Tunisia
| | - Mouna Bellakhdher
- Department of Otorhinolaryngology-Head and Neck Surgery, Farhat Hached University Hospital, Sousse, Tunisia; Sousse Medical School, University of Sousse, Sousse, Tunisia
| | - Mohamed Abdelkefi
- Department of Otorhinolaryngology-Head and Neck Surgery, Farhat Hached University Hospital, Sousse, Tunisia; Sousse Medical School, University of Sousse, Sousse, Tunisia
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10
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Uncommon Insidious Dumbbell-shaped Double Thyroglossal Duct Cyst. J Craniofac Surg 2023; 34:e122-e124. [PMID: 36857559 PMCID: PMC9945057 DOI: 10.1097/scs.0000000000008844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/09/2022] [Indexed: 03/03/2023] Open
Abstract
As one of the most common congenital neck masses, thyroglossal duct cyst (TGDC) developed from the residual ductal epithelial cells in any remnants of thyroglossal duct. However, the reports of double TGDCs were rare. A 60-year-old male was referred to our department because of the presentation of an anterior neck mass. Only a hypodense oval mass inferior to hyoid bone was shown by computed tomography. During the Sistrunk operation, the dumbbell-shaped double TGDCs with the hyoid bone as the pivot were excised. No recurrence was observed. Before surgery, ultrasonography and computed tomography or magnetic resonance imaging should be conducted to verify the locations and sizes of TGDCs. During Sistrunk procedure, the rims of hyoid bone should be checked to avoid possible duct remnants.
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11
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Fakadej T, Balar AB, Kota S, Lakhani DA, Joseph JT. Lingual Thyroid: Case report and brief review of the literature. Radiol Case Rep 2023; 18:312-316. [DOI: 10.1016/j.radcr.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
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12
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HEKİMSOY İ. Diferansiye tiroit karsinomlu olgularda nadir bir tanısal yanılgı sebebi: Lateral servikal ektopik tiroit. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1208962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ektopik tiroit genellikle boyun orta hatta izlenmekle birlikte, nadir olarak lateral yerleşimli de olabilir. Bu çalışmada diferansiye tiroit karsinomu nedeniyle total tiroidektomi uygulanan ve lateral ektopik tiroit dokusu saptanan 4 olgu sunulmaktadır. Operasyon sonrası evreleme için Tc99m perteknetat ile yapılan sintigrafi incelemesinde olguların 3’ünde submandibuler bölgede artmış tutulum izlenen alanda, ultrasonografik incelemede tiroit bezi ile eş ekojenite homojen iç yapıda ektopik tiroit dokusu saptanırken, diğer olguda alt juguler bölgede izlenen heterojen iç yapıda nodüler lezyon, yapılan santral-lateral boyun diseksiyonu sonucunda ektopik tiroit dokusu tanısı almıştır. Metastatik lenf bezi ile primer lateral ektopik tiroit dokusu ayrımı primer tiroit karsinomlu olgularda oldukça önemli olup, laboratuvar verileri, sintigrafi ve ultrasonografiyi içeren tanısal çalışma evrelemede kritik rol oynamaktadır. Oldukça nadir olmakla birlikte ektopik tiroit, lateral boyun kitlelerinin ayırıcı tanısında akılda bulundurulmalıdır.
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Affiliation(s)
- İlhan HEKİMSOY
- Medicana International İzmir Hastanesi, Radyoloji Bölümü, İzmir, Türkiye
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13
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Moschos E, Mentzel HJ. Ultrasound findings of the thyroid gland in children and adolescents. J Ultrasound 2022; 26:211-221. [PMID: 35138597 PMCID: PMC10063727 DOI: 10.1007/s40477-022-00660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022] Open
Abstract
Ultrasonography (US) is an important diagnostic tool in evaluating thyroid diseases in pediatric patients. This pictorial essay reviews the application of various ultrasound techniques such as B-Mode ultrasound and color Doppler, elastography and contrast enhanced ultrasound (CEUS) in children and adolescents in various thyroid pathologies including congenital thyroid abnormalities, diffuse thyroid diseases (DTD), focal thyroid lesions and thyroid malignancy.
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Affiliation(s)
- Elena Moschos
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Hans-Joachim Mentzel
- Section of Paediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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14
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Shumrick CM, Calder AN, Vecchiotti MA, Scott AR. Symptomatic Lingual Thyroglossal Duct Cyst in Children: A Laryngomalacia Phenotype. Ann Otol Rhinol Laryngol 2022; 132:95-99. [PMID: 35100842 DOI: 10.1177/00034894221075082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with lingual thyroglossal duct cyst (TGDC) can present as symptomatic with obstructive airway and feeding difficulties. METHODS We present 3 cases of symptomatic lingual TGDC. RESULTS All 3 patients were diagnosed with laryngomalacia and underwent further concurrent or delayed airway intervention, in addition to cyst removal. CONCLUSIONS We reason that there is a phenotype of laryngomalacia in the symptomatic lingual thyroglossal duct cyst patients who present with symptoms due to disruption in laryngeal anatomy rather than the cyst itself causing obstructive symptoms. Distinguishing this phenotype, especially in comparison to other pathologies such as vallecular cysts, may better allow for planning of concurrent or delayed airway procedures and overall counseling of parents.
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Affiliation(s)
| | - Alyssa N Calder
- Tufts University School of Medicine, Boston, MA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Mark A Vecchiotti
- Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA.,Divisions of Pediatric Otolaryngology and Facial Plastic Surgery, Department of Otolaryngology-Head & Neck Surgery, Tufts Children's Hospital, Boston, MA, USA
| | - Andrew R Scott
- Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA.,Divisions of Pediatric Otolaryngology and Facial Plastic Surgery, Department of Otolaryngology-Head & Neck Surgery, Tufts Children's Hospital, Boston, MA, USA
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15
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Thyroglossal Duct Cyst, a Case Report and Literature Review. Diseases 2022; 10:diseases10010007. [PMID: 35225860 PMCID: PMC8883879 DOI: 10.3390/diseases10010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023] Open
Abstract
A thyroglossal duct cyst (TGDC) is one of the most commonly encountered congenital anomalies of the neck. However, it is difficult to diagnose as differentiating it from other cysts like brachial cysts, lymphangiomas, epidermoid cysts, dermoid cysts, and hydatid cysts, is challenging. In this paper, we systematically reviewed the literature of 47 patients—25 males (53.1%) and 21 females (44.7%)—about their TGDC to assess the clinical picture, therapy, and prognosis of the disease. Most of the patients were children under the age of ten (63.8%). All patients had a history of a painless swelling in the anterior midline of the neck that moved in response to deglutition and tongue protrusion, thus interfering with their daily activity. Post-resection recurrence was unusual, with only 3 of 47 patients (6.4%) experiencing recurrence.
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16
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Ectopic thyroid nodes in the mediastinum - report of two cases. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210828022d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Ectopic thyroid is rare anomaly characterized by presence of
thyroid tissue outside its normal location, which could be the consequence
of developmental abnormality, sequestration of thyroid nodes from nodal
thyroid goiter or mechanical implantation of thyroid tissue after resection
or trauma. Ectopic thyroid commonly is incidentally detected and causes
differential diagnostic dilemma towards the neck and mediastinal tumors. The
object of this report was to present two types of ectopic thyroid nodes
located in the upper mediastinum those were incidentally discovered by
computed tomography (CT). Outline of cases. In a 42-year-old woman with the
adenocarcinoma of esophagogastric junction in whom CT was performed due to
staging purposes, a hyper dense nodular lesion was found in the anterior
upper mediastinum. Metastatic left supraclavicular lymph node was considered
in the differential diagnosis. However, as node was located in front of the
neck fascia and just below the thyroid gland and showed similar density to
thyroid tissue, the diagnosis of accessory thyroid gland was made, which was
later confirmed by multiple repeated CT scans during the two-year follow-up
period. In a 52-year-old woman who was presented with intermittent chest
pain and cough, contrast-enhanced CT scan revealed nodal thyroid goiter and
three nodes of similar CT texture, located in the upper mediastinum, below
the thyroid gland. Accordingly, the diagnosis of parasitic mediastinal
goiter thyroid nodes was made. Conclusion. Ectopic thyroid nodes are
presented by CT as well-circumscribed nodes of same density as the thyroid
gland, typically located anteriorly in the upper mediastinum.
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17
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Onimode YA, Ogunkeyede SA, Afolami P. Distinguishing between isthmic thyroglossal duct cyst and goitre on nuclear thyroid scan: A case report. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2021; 16:108-111. [PMID: 34938400 PMCID: PMC8680951 DOI: 10.51866/cr1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Thyroglossal duct cysts, which are the most frequently encountered congenital cervical anomalies in children, occur due to embryologic remnants of the thyroglossal duct. Although diagnosis may be challenging, clinicians can be aided by imaging and fine-needle aspiration biopsies. We describe the clinical management of a two-year-old boy with a thyroglossal duct cyst mimicking a goitre on a pertechnetate thyroid scan.
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Affiliation(s)
- Yetunde Ajoke Onimode
- MBBS, FCNP(SA), Nuclear Medicine Unit, Department of Radiation Oncology, College of Medicine, University of Ibadan Ibadan, Oyo State, Nigeria
- Department of Nuclear Medicine, University College Hospital, Ibadan Oyo State, Nigeria
| | - Segun Ayodeji Ogunkeyede
- MBCHB, FWACS, FMCORL, Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Otorhinolaryngology, University College Hospital, Ibadan Oyo State, Nigeria,
| | - Peter Afolami
- MBBS, Department of Nuclear Medicine, University College Hospital, Ibadan Oyo State, Nigeria
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18
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Fang N, Angula LN, Cui Y, Wang X. Large thyroglossal duct cyst of the neck mimicking cervical cystic lymphangioma in a neonate: a case report. J Int Med Res 2021; 49:300060521999765. [PMID: 33853437 PMCID: PMC8053768 DOI: 10.1177/0300060521999765] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thyroglossal duct cyst (TGDC) is a congenital neck malformation, with a rate of approximately 7% in paediatric patients. TGDC is rarely detected in infants aged younger than 1 year. Even though TGDC is histologically benign, it is associated with preterm delivery or sudden infant death due to airway obstruction, with a mortality rate of 30% to 40%. We report a rare case of a neonate who presented with a large left lateral neck mass. At 7 to 8 months of gestation, magnetic resonance imaging of the foetal neck showed that there was a high possibility of a cervical cystic lymphangioma. The patient had normal vital signs and was afebrile. She was immediately transferred to our Ear, Nose, and Throat Department for further diagnosis and treatment. A computed tomography scan confirmed a large cystic mass that was positioned against a thyroglossal duct. Excision of the mass in the left neck was performed under general anaesthesia without resecting part of the hyoid bone. A histopathological examination confirmed the diagnosis of a TGDC. Follow-up at 1 year showed no recurrence.
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Affiliation(s)
- Ning Fang
- Department of Otolaryngology, First Hospital of 12510Jilin University, Changchun, China
| | - Laina Ndapewa Angula
- Department of Otolaryngology, First Hospital of 12510Jilin University, Changchun, China
| | - Yu Cui
- Department of Otolaryngology, First Hospital of 12510Jilin University, Changchun, China
| | - Xin Wang
- Department of Otolaryngology, First Hospital of 12510Jilin University, Changchun, China
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19
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Reddy R. High-resolution ultrasonography of infected thyroglossal duct cyst. APOLLO MEDICINE 2021. [DOI: 10.4103/am.am_87_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Qin LH, He FY, Liao JY. Multiple ectopic goiter in the retroperitoneum, abdominal wall, liver, and diaphragm: A case report and review of literature. World J Clin Cases 2020; 8:6172-6180. [PMID: 33344620 PMCID: PMC7723730 DOI: 10.12998/wjcc.v8.i23.6172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/19/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ectopic thyroid is a rare developmental disorder, typically found in lingual areas, and most distantly in the abdomen. Thyroid ectopia in multiple regions is extremely rare. To date, there are no reports of ectopic goiter in four regions of the abdominal cavity in a single patient. CASE SUMMARY We present a case of thyroid ectopia in four areas of the abdomen, comprising normal orthotopic thyroid tissue. A 36-year-old woman, who underwent ovarian teratoma resection 10 years previously due to symptomatic ovarian teratoma, was referred to our hospital for treatment of an incidental hepatic mass. Magnetic resonance imaging and computed tomography (CT) of the abdomen showed a heterogeneously enhanced lobulated lesion in the sixth and seventh hepatic segment adjacent to the diaphragm. The mass was surgically excised, and histologic examination determined an ectopic nodular goiter. At the one-year follow-up, the abdominal CT scan, whole-body radionuclide I131 examination, and abdominal wall biopsy showed similar lesions in the left renal fascia and anterior abdominal wall. CONCLUSION Multiple para-ectopic thyroid is often misdiagnosed, owing to its extremely rare incidence and non-specific clinical manifestations and imaging features. A combination of multiple examinations is necessary for diagnostic accuracy.
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Affiliation(s)
- Lan-Hui Qin
- Department of Radiology, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Feng-Yi He
- Department of Radiology, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jin-Yuan Liao
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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21
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Qin LH, He FY, Liao JY. Multiple ectopic goiter in the retroperitoneum, abdominal wall, liver, and diaphragm: A case report and review of literature. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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22
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Diagnostic Approach to Evaluating Superficial Masses on Ultrasound. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Kato H, Kawaguchi M, Ando T, Kaneko Y, Hyodo F, Matsuo M. Hypointense head and neck lesions on T2-weighted images: correlation with histopathologic findings. Neuroradiology 2020; 62:1207-1217. [PMID: 32562036 DOI: 10.1007/s00234-020-02483-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE On T2-weighted images, most solid lesions exhibit nonspecific intermediate signal intensity, whereas most cystic lesions exhibit marked hyperintensity. In contrast, on T2-weighted images, a relatively small number of lesions exhibit hypointensity. This review aimed to differentiate, according to the histopathologic findings, head and neck lesions showing hypointensity on T2-weighted images. METHODS In this review article, hypointense head and neck lesions on T2-weighted images are classified into the following nine categories: calcified or osseous lesions, granulomatous lesions, fibrous lesions, mucous- or proteincontaining lesions, hemosiderin-containing lesions, melanin-containing lesions, thyroglobulin-containing lesions, rapid blood flow, and air-filled spaces. CONCLUSION Knowledge regarding hypointense head and neck lesions on T2-weighted images allows radiologists to make accurate differential diagnoses. Key points • Hypointense head and neck lesions on T2-weighted images include calcified or osseous lesions, granulomatous lesions, fibrous lesions, mucous- or protein-containing lesions, hemosiderin-containing lesions, melanin-containing lesions, thyroglobulin-containing lesions, rapid blood flow, and air-filled spaces. • Radiologists should recognize the hypointense head and neck lesions on T2-weighted images for the final correct diagnosis, resulting in appropriate patient management.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tomohiro Ando
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yo Kaneko
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Fuminori Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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24
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Chapman MC, Soares BP, Li Y, Shum DJ, Glenn OA, Glastonbury CM, Courtier JL. Congenital Oral Masses: An Anatomic Approach to Diagnosis. Radiographics 2020; 39:1143-1160. [PMID: 31283464 DOI: 10.1148/rg.2019180128] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although congenital oral masses are rare, they are readily detectable during fetal US screening. Most congenital oral masses are benign, but some may cause mechanical airway obstruction, resulting in poor outcomes at delivery. The radiologist's ability to describe these abnormalities and their physiologic sequelae accurately can have a substantial effect on perinatal treatment. Furthermore, despite being rare, congenital oral lesions encountered at screening and at follow up fetal MRI provide the opportunity to make a specific diagnosis by following a simple anatomic approach. This article describes an anatomic algorithm as the framework for accurate diagnosis of congenital oral lesions. The imaging appearance of the most common congenital oral cavity neoplasms is outlined, including vascular anomalies, epulides, choristomas, congenital lingual thyroid anomalies, lingual hamartomas, and epignathi, and other conditions that mimic these at US. Also reviewed are perinatal management of masses that affect the fetal airway and the imaging features key to optimizing delivery outcomes. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Molly C Chapman
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Bruno P Soares
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Yi Li
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Dorothy J Shum
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Orit A Glenn
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Christine M Glastonbury
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Jesse L Courtier
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
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25
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Thyroglossal duct cysts and site-specific differential diagnoses: imaging findings with emphasis on ultrasound assessment. J Ultrasound 2020; 23:139-149. [PMID: 32052384 DOI: 10.1007/s40477-020-00433-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Thyroglossal duct cysts (TGDCs) are the most common congenital abnormality of the neck, accounting for approximately 70% of congenital neck lesions. Two-thirds of thyroglossal duct anomalies are diagnosed within the first three decades of life, with more than half being identified before 10 years of age. The age of presentation, clinical examination and imaging are essential for an accurate diagnosis. This review aims to summarize the imaging findings of TGDCs and their main differential diagnoses with emphasis on ultrasound assessment. A focus on site-specific key differentiating between them is also addressed.
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26
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Thyroid Embryonic Anomalies Involving the Medial and Lateral Anlagen: Two Surgical Case Reports. Case Rep Surg 2019; 2019:3174848. [PMID: 31886006 PMCID: PMC6915127 DOI: 10.1155/2019/3174848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/19/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction An ectopic anomalous accessory thyroid is extremely rare. We present two related case reports. Case A 43-year-old morbidly obese female presented with a palpable left thyroid mass. Initial impression after preoperative workup was a diffuse bilateral multinodular goiter with a left nodule suspicious for malignancy. She underwent a total thyroidectomy. On further palpation after initial excision, two masses on the left neck area were noted, dissected, and excised. In the second case, a 65-year-old female presented with a substernal exophytic mass displacing the trachea to the right after a left thyroid lobectomy 4 years ago. Cytology revealed a retained substernal thyroid. She is scheduled for a substernal thyroidectomy through a median sternotomy. Discussion In all partial or complete thyroidectomy cases, care should be taken to palpate or to use intraoperative ultrasound (IOUS) for any extra thyroid mass. An intuitive surgical approach is needed to evaluate for possible embryologic anomalies of the thyroid. There are two thyroid anlagen that can explain ectopic aberrant anomalies: the median anlage-thyroid rest and the lateral anlage from the ultimobranchial body of the fourth pharyngeal pouch. Surgeons should keep in mind that multiple ectopic thyroid glands could be present in any thyroidectomy procedure.
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27
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Lee YJ, Kim DW, Shin GW, Park JY, Choo HJ, Park HK, Ha TK, Kim DH, Jung SJ, Park JS, Moon SH, Ahn KJ, Baek HJ. Comparison of Prevalence and Ultrasonography Features of Thyroglossal Duct Cyst in Adults According to Radioactive Iodine Ablation. Med Sci Monit 2019; 25:9538-9546. [PMID: 31837133 PMCID: PMC6929556 DOI: 10.12659/msm.919324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the prevalence of thyroglossal duct cysts (TGDCs) on ultrasonography (US) and US features of TGDCs in adults, and to assess whether the prevalence or size of TGDCs increases after radioactive iodine ablation (RIA). MATERIAL AND METHODS Between July and December 2018, 2820 patients underwent thyroid or neck US examination, performed by 2 radiologists, at our center. On the basis of real-time US, the presence or absence of TGDCs was prospectively investigated by 2 radiologists. Among the 2820 patients, 54 patients who were <19 years of age or had a radiation therapy history to the neck were excluded. Eventually, 2766 patients were included. RESULTS Of the 2766 patients, 160 (5.8%) showed a TGDC on US. The mean size of TGDCs in RIA history (+) (n=36) and RIA history (-) (n=124) groups was 0.92±0.41 cm and 0.86±0.45 cm, respectively. There was no significant difference in size of TGDCs between RIA history (+) and RIA history (-) groups (p=0.684). Between the TGDC (+) and TGDC (-) groups, there was no significant difference in patient age, gender, reason for thyroid/neck US, type of thyroid surgery, and session number and application/no application of RIA (p>0.05). The prevalence rate of TGDCs in radiologist A and B was 4.9% (70/1427) and 6.7% (90/1339), respectively. TGDCs were more common in the suprahyoid neck, and the common shapes of TGDCs were flat-to-ovoid and round. CONCLUSIONS RIA may not be associated with the prevalence or enlargement of TGDCs.
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Affiliation(s)
- Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Gi Won Shin
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jin Young Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hye Jung Choo
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ha Kyoung Park
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Tae Kwun Ha
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Do Hun Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Soo Jin Jung
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ji Sun Park
- Department of Nuclear Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sung Ho Moon
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
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Rajaraman V, Ponnusamy M. Retrosternal Ectopic Thyroid Mimicking Esophagus in Tc-99m Pertechnetate Thyroid Scan. Indian J Nucl Med 2019; 34:351-352. [PMID: 31579360 PMCID: PMC6771198 DOI: 10.4103/ijnm.ijnm_84_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abnormal Pertechnetate distribution can occur due to many reasons such as retrosternal extension of eutopic thyroid gland, ectopic functioning thyroid gland, physiological uptake in esophagus, teratoma having functioning thyroid tissue component, metastatic lymph nodes and sequestered thyroid nodule. We present a case of thyrotoxicosis with hyper functioning thyroid gland and two abnormal foci of uptake in the mediastinum in a linear fashion that mimcked esophageal activity. These foci persisted even after consuming water. SPECT localised these foci in retrosternal and likely to be ectopic functioning thyroid. Retrosternal ectopic thyroid tissue may not usually be detected on Tc-99m scan due to attenuation of low-energy gamma rays by sternal bone. However, hyperfunctioning tissue enabled visualization of the retrosternal ectopic thyroid.
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Affiliation(s)
- Vishnukumar Rajaraman
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Madhusudhanan Ponnusamy
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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29
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Thyroglossal Duct Carcinoma Originating in the Hyoid Bone. Case Rep Radiol 2019; 2019:3067346. [PMID: 31355039 PMCID: PMC6633968 DOI: 10.1155/2019/3067346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/10/2019] [Indexed: 11/17/2022] Open
Abstract
Thyroglossal duct (TGD) carcinoma is a rare malignant tumor arising from remnants of thyroid tissue or the wall of the duct and generally occurs along the anatomic course of the TGD. TGD carcinoma originating in the hyoid bone is extremely rare but can occur since the TGD penetrates the hyoid bone on rare occasions. This report describes the case of a 30-year-old man with TGD carcinoma originating in the hyoid bone. Computed tomography demonstrated a mass in the hyoid bone that expanded the cortical bone of the hyoid. The mass had a central solid component with calcification and a marginal cystic component. When we encounter a calcified mass in the hyoid bone, we should consider TGD carcinoma among the differential diagnoses.
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30
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Preoperative ultrasound for the diagnosis of thyroglossal duct cysts: A validation study. Int J Pediatr Otorhinolaryngol 2019; 122:89-92. [PMID: 30991206 DOI: 10.1016/j.ijporl.2019.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the use of ultrasound to distinguish between thyroglossal duct cysts (TGDC) and dermoid cysts (DC) for surgical planning. To validate the SIST (septae + irregular wall + solid components = TGDC) scoring system proposed by Oyewumi et al. [1]. METHODS This was a retrospective chart review of pediatric patients with midline neck masses who presented between the years of 2005 and 2014 and underwent preoperative ultrasound and surgical resection. Two pediatric radiologists blinded to diagnosis reviewed each US for 14 separate characteristics. According to the SIST scoring system, one point was given for each of the following: internal septae, irregular walls, and solid components. RESULTS 45 patients met inclusion criteria. Final pathologic diagnosis showed 29 patients had TGDC, 16 had DC. The majority of patients with both TGDC and DC earned SIST scores of 0. CONCLUSION While ultrasound remains a useful part of the work-up of lesions of the head and neck in children, this small retrospective study was not able to validate the previously proposed SIST scoring system None of the parameters discussed in the original paper was found to be a statistically significant determinant of TGDC.
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31
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Batchala PP, Dyer A, Mukherjee S, Rehm PK. Lateral ectopic thyroid mimics carotid body tumor on Indium-111 pentetreotide scintigraphy. Clin Imaging 2019; 58:46-49. [PMID: 31238185 DOI: 10.1016/j.clinimag.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022]
Abstract
A 34-year old woman with past history of anxiety, depression, and hypothyroidism resulting from prior total thyroidectomy for multinodular goiter presented with complaints of palpitations, sweating, and tachycardia. Clinical examination revealed a painless right lateral neck mass. USG/CT of the neck revealed the soft tissue mass located at the right carotid bifurcation. A subsequent Indium-111 pentetreotide somatostatin receptor scintigraphy (SRS) demonstrated tracer uptake in the mass. Hence, secretory carotid body tumor/paraganglioma was strongly suspected. However, post-surgical histopathological specimen revealed only benign thyroid follicles indicative of lateral ectopic thyroid with no evidence of neuroendocrine cells or malignancy. This case highlights the importance of considering lateral ectopic thyroid, a very rare entity, in the differential diagnosis for carotid bifurcation masses. Also highlighted is the false positivity from normal but ectopic thyroid tissue on Indium-111 pentetreotide SRS mimicking a paraganglioma.
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Affiliation(s)
- Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Anthony Dyer
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Patrice K Rehm
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
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The effectiveness of transoral marsupialization for lingual thyroglossal duct cysts - Twelve successfully treated cases at a single institution. J Pediatr Surg 2019; 54:766-770. [PMID: 30732933 DOI: 10.1016/j.jpedsurg.2018.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE Lingual thyroglossal duct cysts (L-TGDCs) are rare and sometimes lethal owing to their association with asphyxia. We aimed to analyze our single institutional experience with L-TGDCs. METHODS Twelve L-TGDC cases treated at our institution between January 2010 and December 2017 were investigated. RESULTS The male/female ratio was 6/6. The age at the diagnosis was 2 ± 1.4 months (7 days to 6 months), and 3 patients were diagnosed in the neonatal period. The patients presented with stridor (n = 12; 100%), growth retardation (n = 5; 42%), apnea (n = 3; 25%), and vomiting (n = 1; 8.3%). Lateral X-rays were obtained in 8 cases (66.7%); a lingual mass was suspected in 7 (87.5%). Transoral marsupialization of the cyst was performed under direct vision in all cases. All cases were nasally and orally intubated using a laryngoscope, bronchoscope, or airway scope. The mean operative time was 18 ± 2.9 min. The mean cyst size was 10.5 ± 1.8 mm. No recurrence was observed during the follow-up period (37.5 ± 18 months). CONCLUSION L-TGDC requires a precise diagnosis and rapid intervention because of the risk of asphyxia resulting in sudden death. Transoral marsupialization under direct vision is an effective and secure approach. L-TGDC should be considered when patients younger than six months of age present with respiratory distress. TYPE OF STUDY Retrospective Study. LEVEL OF EVIDENCE Level IV.
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33
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Patel S, Bhatt AA. Thyroglossal duct pathology and mimics. Insights Imaging 2019; 10:12. [PMID: 30725193 PMCID: PMC6365310 DOI: 10.1186/s13244-019-0694-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/15/2019] [Indexed: 12/17/2022] Open
Abstract
Congenital anterior neck masses comprise a rare group of lesions typically diagnosed in childhood. Most commonly, lesions are anomalies of the thyroglossal duct, namely the thyroglossal duct cyst, along with ectopic thyroid tissue. Although usually suspected based on clinical examination, imaging can confirm the diagnosis, assess the extent, and evaluate for associated complications. Imaging characteristics on ultrasound, CT, and MRI may at times be equivocal; differential considerations include branchial cleft cyst, dermoid/epidermoid, laryngocele, thymic cyst, lymphatic malformation, and metastatic disease. Thus, understanding of the embryologic course of thyroid development is crucial with recognition of critical landmarks such as the foramen cecum, hyoid bone, thyroid cartilage, and strap musculature to aid in the diagnosis of an anterior neck mass.
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Affiliation(s)
- Swapnil Patel
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA.
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA
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Ectopic thyroid tissue presenting as a new neck mass in a pediatric patient. Radiol Case Rep 2018; 14:55-57. [PMID: 30364699 PMCID: PMC6197941 DOI: 10.1016/j.radcr.2018.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/24/2022] Open
Abstract
Ectopic thyroid tissue is an uncommon, but well-documented condition. We present a case of an ectopic thyroid gland with an atypical presentation as a new neck mass in a 3-year-old female without symptoms of hypothyroidism. Imaging confirmed ectopic thyroid and suggested thyroiditis due to hyperemia and heterogeneity on ultrasound. However, there were no laboratory findings of hypothyroidism. An understanding of anatomy and sonographic features of ectopic thyroid gland allows the radiologist to provide a more accurate differential diagnosis in the setting of a neck mass.
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35
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Frank SJ, Koenigsberg T, Gutman D, Koenigsberg M. Applications of 3-Dimensional Ultrasonography in the Neck, Excluding the Thyroid. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1791-1806. [PMID: 29288583 DOI: 10.1002/jum.14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/27/2017] [Accepted: 09/30/2017] [Indexed: 06/07/2023]
Abstract
Ultrasonography (US) of the neck is an accepted, useful imaging modality for many applications beyond its usefulness in thyroid disease. Two-dimensional US has been effectively used for evaluation of many types of neck conditions, and now, 3-dimensional US can be added to the imaging armamentaria. Three-dimensional US is useful in the evaluation of cervical lymph nodes, recurrent/residual thyroid neoplasia, parathyroid glands, parotid and submandibular glands, as well as thyroglossal duct cysts and other assorted palpable and visible abnormalities because of its unique capabilities, including multiplanar reconstruction, accessibility of the coronal view, volume calculation, and regularly spaced incremental slice evaluation.
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Affiliation(s)
- Susan J Frank
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tova Koenigsberg
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Gutman
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mordecai Koenigsberg
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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36
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Bansal AG, Oudsema R, Masseaux JA, Rosenberg HK. US of Pediatric Superficial Masses of the Head and Neck. Radiographics 2018; 38:1239-1263. [DOI: 10.1148/rg.2018170165] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Anmol Gupta Bansal
- From the Department of Radiology, Kravis Children’s Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
| | - Rebecca Oudsema
- From the Department of Radiology, Kravis Children’s Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
| | - Joy A. Masseaux
- From the Department of Radiology, Kravis Children’s Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
| | - Henrietta Kotlus Rosenberg
- From the Department of Radiology, Kravis Children’s Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
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Abstract
Ectopic thyroid tissue is very rare, but its prevalence increases in those with thyroid pathology. It typically occurs due to aberrant development of the thyroid gland during its migration to the pretracheal region. In this report, there are two cases of mediastinal ectopic thyroid tissue discussed, which were initially considered to be malignancies. The hospital course, diagnostic workup, including the use of computed tomography and positron emission tomography scans, and the characteristic features of the tissue are examined here. Due to the imaging characteristics, it is important to consider ectopic thyroid tissue as a differential diagnosis for mediastinal masses as encountered in these cases. Asymptomatic ectopic thyroid tissue is usually treated medically; however, patients in both of our cases opted for surgical resection of the masses even after confirmation of the origin of the tissues.
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Affiliation(s)
- Yazdan Raji
- Department of Radiology and Imaging, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Supriya Gupta
- Department of Radiology and Imaging, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Darko Pucar
- Department of Radiology and Imaging, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jayanth H Keshavamurthy
- Department of Radiology and Imaging, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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38
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Nightingale M. Midline cervical swellings: What a paediatrician needs to know. J Paediatr Child Health 2017; 53:1086-1090. [PMID: 29148189 DOI: 10.1111/jpc.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 11/30/2022]
Abstract
Midline cervical swellings are a heterogeneous group of conditions in children. Careful clinical examination will allow a diagnosis to be made in many instances and appropriate investigations to be performed before referral to surgical services. The approach to clinical examination, investigation and management of the most common conditions is described.
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Affiliation(s)
- Michael Nightingale
- Paediatric Surgery, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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39
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Thyroglossal duct cysts in children: Sonographic features every radiologist should know and their histopathological correlation. Clin Imaging 2017; 46:57-64. [DOI: 10.1016/j.clinimag.2017.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/19/2017] [Accepted: 07/07/2017] [Indexed: 11/18/2022]
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40
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Kligerman SJ, Auerbach A, Franks TJ, Galvin JR. Castleman Disease of the Thorax: Clinical, Radiologic, and Pathologic Correlation: From the Radiologic Pathology Archives. Radiographics 2017; 36:1309-32. [PMID: 27618318 DOI: 10.1148/rg.2016160076] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Castleman disease is a complex lymphoproliferative disease pathologically divided into two subtypes, the hyaline vascular variant (HVV) and the plasma cell variant (PCV). The HVV is the most common, is thought to represent a benign neoplasm of lymph node stromal cells, and is treated with surgical resection. It is most commonly found in the mediastinum, where it classically appears as a unicentric, avidly enhancing mass at computed tomography (CT) and magnetic resonance imaging. This appearance can mimic other avidly enhancing mediastinal masses, and location, clinical history, laboratory data, and nuclear medicine single photon emission CT (SPECT) and positron emission tomography (PET) studies can help narrow the differential diagnosis. Multicentric Castleman disease (MCD), which in the majority of cases is composed of the PCV, is an aggressive lymphoproliferative disorder associated with human herpesvirus infection, interleukin 6 dysregulation, and other systemic disorders. While it can be difficult to differentiate MCD from lymphoma, the presence of avidly enhancing lymph nodes can suggest the diagnosis. The purpose of this article is to review the clinical, immunologic, and pathologic findings associated with both unicentric Castleman disease and MCD and discuss how the imaging findings correlate with the pathophysiology of the disease.
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Affiliation(s)
- Seth J Kligerman
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Aaron Auerbach
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Teri J Franks
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Jeffrey R Galvin
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
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41
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Pierro A, Cilla S, Modugno P, Sallustio G. Incidental Finding of Dual Ectopic Thyroid on Computed Tomography Angiography. J Clin Imaging Sci 2017; 7:30. [PMID: 28852580 PMCID: PMC5559925 DOI: 10.4103/jcis.jcis_21_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 11/04/2022] Open
Abstract
The presence of simultaneous two ectopic foci of thyroid tissue (dual ectopic thyroid) is rare, and few cases have been reported in the literature. The ectopic thyroid tissue is an extremely uncommon embryological aberration due to the alterations occurring during the embryological development with incomplete migration of thyroid precursors. Commonly ectopic thyroid tissue is a midline structures, but the lateral location is possible but very rare. Ectopic thyroid is common in women and can vary in size from a microscopic focus to a few centimeters. The normal process of migration of the thyroid can be interrupted at various levels determining a lingual ectopy, a sublingual ectopic, prelaryngeal ectopy, or mediastinic ectopy. Intrathoracic and subdiaphragmatic organs are other sites where the ectopic thyroid tissue may be present. In most of the cases, ectopic tissue is a lingual thyroid and this condition can be totally asymptomatic, discovered incidentally, or occurs with symptoms such as dysphonia, dysphagia, dyspnea, and hemoptysis. Sublingual or suprahyoid ectopia is rare and even rarer are the cases of two foci of ectopic thyroid tissue simultaneously present. On imaging, the ectopic tissue shows the same characteristics of orthotopic thyroid tissue and similarly can undergo goiterous and cancerous transformation. We report a case of incidental dual ectopic thyroid in lingual and suprahyoid level in a 72-year-old female patient, asymptomatic and with normal thyroid function, who underwent computed tomography (CT) angiography before vascular surgery for the treatment of carotid stenosis. The presence of a lingual thyroid can lead to a difficult and dangerous intubation, with possible fatal consequences. For this reason, the discovery of these abnormalities has totally changed the patient management who has been subjected to endovascular treatment, instead to the classical surgery.
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Affiliation(s)
- Antonio Pierro
- Radiology Unit, Foundation of Research and Cure "John Paul II", Catholic University of Sacred Heart, Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Foundation of Research and Cure "John Paul II", Catholic University of Sacred Heart, Campobasso, Italy
| | - Pietro Modugno
- Vascular Surgery Unit, Foundation of Research and Cure "John Paul II", Catholic University of Sacred Heart, Campobasso, Italy
| | - Giuseppina Sallustio
- Radiology Unit, Foundation of Research and Cure "John Paul II", Catholic University of Sacred Heart, Campobasso, Italy
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42
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Chua WY, Langer JE, Jones LP. Surveillance Neck Sonography After Thyroidectomy for Papillary Thyroid Carcinoma: Pitfalls in the Diagnosis of Locally Recurrent and Metastatic Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1511-1530. [PMID: 28393379 DOI: 10.7863/ultra.16.08086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/23/2016] [Indexed: 06/07/2023]
Abstract
A sonographic examination of the neck performed 6 to 12 months after thyroid surgery in patients with differentiated thyroid cancer is strongly recommended by the American Thyroid Association and considered mandatory by the European Thyroid Association for locoregional surveillance. The aim of this article is to review the normal anatomic changes expected after thyroid surgery and the pathologic mimics of thyroid carcinoma recurrence in post-thyroidectomy patients as they appear on neck sonography. We hope to offer some pearls to increase diagnostic confidence in this setting.
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Affiliation(s)
- Wynne Yuru Chua
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Jill E Langer
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa P Jones
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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43
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Thompson LDR, Herrera HB, Lau SK. Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review. Head Neck Pathol 2017; 11:442-449. [PMID: 28293858 PMCID: PMC5677077 DOI: 10.1007/s12105-017-0807-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
Abstract
Thyroglossal duct cyst (TGDC) carcinomas are rarely encountered in the pediatric population. The clinical behavior of these tumors in the pediatric setting is unclear and management is not well defined. Two cases of pediatric thyroglossal duct cyst carcinoma were identified in a review of all thyroglossal duct cysts diagnosed over a ten year period. These two cases were analyzed along with 57 cases of thyroglossal duct cyst carcinoma affecting patients less than 21 years of age compiled from the English literature. Fifty-nine patients (36 females, 23 males) aged 6-20 years (mean 15.0 years) were identified. All presented with an anterior midline neck mass, which was typically mobile and non-tender. The average tumor size was 2.6 cm. Histologically, all tumors were papillary thyroid carcinomas arising in a background of a thyroglossal duct cyst. The tumors exhibited a papillary, follicular, or mixed architecture with classical papillary thyroid carcinoma nuclear features. Soft tissue extension was present in 16 cases. All patients were managed surgically with a Sistrunk procedure, with additional thyroidectomy performed in 29 patients, combined with a lymph node dissection (n = 15), or a Sistrunk and lymph node dissection (n = 5). All patients were stage I at presentation, with 11 showing lymph node metastases. Postoperative radioactive iodine was employed in 20 patients. A papillary carcinoma of the thyroid gland was reported in four of the patients who had concurrent/subsequent thyroidectomies. Recurrences were reported in four patients, with distant metastases in one patient, who died of disease (13 months). Follow up data was available for 45 patients, with an overall mean follow-up of 54.5 months. All patients were alive, with the exception of one who died with disease. TGDC carcinomas in pediatric patients is associated with a good overall prognosis, best managed by Sistrunk procedure alone, with selected lymph node dissection if clinically indicated.
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Affiliation(s)
- Lester D. R. Thompson
- 0000 0004 0445 0789grid.417224.6Southern California Permanente Medical Group, Department of Pathology, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
| | - Hannah B. Herrera
- 0000 0004 0445 0789grid.417224.6Southern California Permanente Medical Group, Department of Pathology, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
| | - Sean K. Lau
- Department of Pathology, Orange County-Anaheim Medical Center, Anaheim, CA USA
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44
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Ectopic Thyroid Tissue in the Mediastinum Characterized by Histology and Functional Imaging with I-123 SPECT/CT. Case Rep Radiol 2017; 2017:9084207. [PMID: 28251012 PMCID: PMC5303849 DOI: 10.1155/2017/9084207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/24/2016] [Accepted: 01/10/2017] [Indexed: 12/18/2022] Open
Abstract
Ectopic thyroid tissue is a rare entity and when discovered it is typically along the pathway of embryologic migration of the thyroid. We present a case of incidental finding of ectopic thyroid tissue within mediastinum in a 61-year-old female patient with a history of total thyroidectomy for thyroiditis and nodules. The patient presented to emergency room with cough and right chest pain and underwent a chest computed tomographic angiogram (CTA) to exclude pulmonary embolism as part of chest pain workup. One right paratracheal mediastinal soft tissue nodule was visualized on the images of CTA. This right paratracheal soft tissue mass was found to be ectopic benign thyroid tissue by histological analysis of the biopsied tissue samples. The function of this ectopic thyroid tissue was characterized by I-123 radioiodine uptake and single photon emission computed tomography/computed tomography (SPECT/CT) imaging. This case illustrates that ectopic thyroid tissue should be included for differential diagnosis of a hyperdense soft tissue mass located within mediastinum. I-123 SPECT/CT is useful for guiding tissue biopsy of ectopic thyroid tissue distant from orthotopic thyroid gland and functional and anatomic characterization of mediastinal ectopic thyroid tissue for surgical resection when it is medically necessary.
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45
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Abstract
Double thyroglossal duct cysts (TDCs) are a very rare congenital malformation. Herein, we report a rare case of double TDCs, one below the hyoid bone and the other at the base of the tongue. Clinicians should be aware that TDCs can occur as multiple cystic lesions. Preoperative radiological examinations should be performed for an accurate diagnosis of double TDCs.
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46
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A unique presentation of ectopic thyroid, a case report. Int J Surg Case Rep 2016; 29:185-188. [PMID: 27866035 PMCID: PMC5121164 DOI: 10.1016/j.ijscr.2016.10.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/30/2016] [Indexed: 12/29/2022] Open
Abstract
Previous description of ectopic thyroid tissue has not included point tenderness as a presenting symptom. Ectopic Thyroid shoudl be included in teh differential diagnosis of point tenderness with an associated mass or lesion on imaging. Management of both symptomatic ectopic thyroid and esophageal perforation with periesophageal abscess is surgical intervention. It is important to perform due diligence in the work up of a patient without compromising the patient’s safety to do so.
Introduction This case presents a painful ectopic thyroid, an unusual presentation, in an atypical location. The patient’s history of an ingested fish bone, her acute presentation, and inconclusive imaging, made this case a diagnostic dilemma. Presentation of case 61-year-old female presented with acutely worsening history of left throat pain and dysphagia after swallowing a fish bone. CT scan showed a foreign body in the anterior wall of the cervical esophagus. EGD studies were inconclusive. Surgical exploration identified and excised a multinodular cystic lesion without connection to esophageal lumen. Pathology described multinodular thyroid parenchyma with chronic inflammation and no evidence of malignancy. No foreign body was located. Discussion Based on the patient’s history, imaging, and acute presentation, an esophageal perforation with abscess formation was the most likely diagnosis. Surgical exploration was the necessary intervention for this patient’s acute symptoms as both a diagnostic and therapeutic tool. The diagnosis of ectopic thyroid tissue from pathology of the excised cystic lesion was unexpected, as the location of tissue and the painful presentation are not typical characteristics of ectopic thyroid tissue. Management of the this case illustrates the dilemma faced in determining the appropriate work up for a patient, without compromising the patient’s safety. Conclusion Though painful presentation and this case’s location are rare, ectopic thyroid tissue should be included in the differential diagnosis of point tenderness with an associated lesion on imaging.
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47
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Brown RE, Harave S. Diagnostic imaging of benign and malignant neck masses in children-a pictorial review. Quant Imaging Med Surg 2016; 6:591-604. [PMID: 27942480 DOI: 10.21037/qims.2016.10.10] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neck masses are frequently encountered in pediatric medicine, and can present a diagnostic dilemma for the clinicians involved. There are several means by which neck masses in children can be subdivided, for example by age at presentation, anatomical location including compartments and fascia of the neck, their classical appearance when imaged, or by etiology. When imaging children the clinicians must be mindful of radiation exposure and as such ultrasound (US) is often attempted first. Cross sectional imaging can be helpful for problem solving with CT being particularly useful for assessing the patient in more acute scenarios, for example when there is airway compromise. Nuclear medicine scintigraphy has a role in specific circumstances and can aid in staging in the presence of malignancy. If required, additional acquisition by means of magnetic resonance imaging (MRI) and computed tomography (CT) can be considered. This pictorial review describe the diagnostic imaging of (I) congenital and Developmental Pathologies, including thyroglossal duct cyst, branchial cleft cyst, cystic hygroma, dermoid cyst, thymic cyst and ectopic thymus; (II) neoplastic lesions, including hemangiomas and vascular malformations, pilomatrixoma, neurofibroma, neuroblastoma, rhabdomyosarcoma, papillary thyroid cancer, lymphoma & leukemia; (III) neck masses of Infective causes, including lymphadenitis, retropharyngeal and peritonsilar abscess, salivary gland inflammation; and (IV) other miscellaneous lesions, including ranula, sternocleidomastoid fibromatosis coli, and goiter. Neck masses are common in the pediatric population with a broad and varied differential; malignant etiologies are less frequently encountered when compared with adults but an awareness of its potential is important when reviewing imaging.
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Affiliation(s)
| | - Srikrishna Harave
- Department of Radiology, Alder Hey Children's Hospital, Liverpool, UK
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48
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Yim MT, Tran HD, Chandy BM. Incidental radiographic findings of thyroglossal duct cysts: Prevalence and management. Int J Pediatr Otorhinolaryngol 2016; 89:13-6. [PMID: 27619021 DOI: 10.1016/j.ijporl.2016.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/17/2016] [Accepted: 07/21/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine the epidemiology of incidental thyroglossal duct cysts (TGDC) discovered on imaging studies obtained in the head and neck area in children and to discuss subsequent management. METHODS A retrospective chart review was performed at Texas Children's Hospital of all computed tomography (CT) and magnetic resonance (MR) imaging studies obtained in the head and neck region between July 2011 and July 2014. Images obtained for the purpose of evaluating a neck or lingual mass were excluded from the study, as were patients with previously known TGDCs. Data including age, sex, location of TGDC, size, presence of symptoms, referral to Otolaryngology, and intervention were recorded. RESULTS A total of 60,663 CT and MR studies of the head, brain, sinus, neck, and C-spine during this time period were reviewed; of these 69 (0.1%) cases contained incidental discovery of probable TGDCs with more males (40) than females (29). Ages ranged from 3 days to 17 years old, with the mean age at 5 years. Locations varied, with majority at base of tongue (83%) followed by hyoid (13%) then infrahyoid straps (4%). Sizes ranged from 2 to 28 mm with average size at 8 mm. 11 of these patients were referred to an Otolaryngologist; 9 were asymptomatic and decision was made to observe, the other two subsequently underwent surgical excision secondary to mass effect and dysphagia with histologic confirmation of diagnosis. CONCLUSION TGDCs commonly present as an anterior neck mass, however the majority of incidentally discovered TGDCs on imaging are located at the base of tongue. Management of these findings should include referral to an Otolaryngologist for further evaluation with the decision to intervene surgically based on development of clinical symptoms.
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Affiliation(s)
- Michael T Yim
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, One Baylor Plaza, Mail Stop: NA-102, Houston, TX 77030, USA.
| | - Huy D Tran
- Department of Pediatric Radiology, Neuroradiology Section, Texas Children's Hospital, 6701 Fannin Street, Suite 470, MC 2-270, Houston, TX 77030, USA.
| | - Binoy M Chandy
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, One Baylor Plaza, Mail Stop: NA-102, Houston, TX 77030, USA; Division of Otolaryngology, Texas Children's Hospital, Houston, TX, USA.
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Brea Álvarez B, Tuñón Gómez M, Esteban García L, García Hidalgo C, Ruiz Peralbo R. Nontraumatic head and neck emergencies: A clinical approach. Part 1: Cervicofacial swelling, dysphagia, and dyspnea. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea. RADIOLOGIA 2016; 58:329-42. [PMID: 27520826 DOI: 10.1016/j.rx.2016.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/23/2022]
Abstract
Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients.
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