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PG: Nasin Usman

Moderator: Dr. Priya

 First used imaging modality
 Position: supine, hyperextended neck
 High frequency linear transducer (5-12 MHz)
 Transverse and longitudinal planes
 Detection of lymphadenopathy, salivary gland and soft
tissue pathologies
 Most sensitive imaging test for examination of thyroid
gland focal lesions and diffuse abnormalities in the
thyroid parenchyma
 Characterization of mass vascularization and for the
accurate evaluation of neck vessels
 FNAC and core needle biopsy
 Percutaneous treatment
 2 lobes – connected by isthmus
 Length: 4-6 cm
 AP/ Transverse:
1.3 -1.8 cm
 Isthmus: 3mm

AP > 2 cm
Isthmus > 4 mm
Homogenous echopattern, hyperechoic compared to the neck muscles.
Anechoic vessels – JV(compressible), CA (non compressible & pulsatile)
 STA – from ECA – supply upper pole
 ITA – TCT – to deep part of the gland
 Variable thyroidea ima (3%) from BCA/Aorta
 Sup and middle thyroid veins into IJV
 Inf thyroid veins into left BCV
Development from base of
tongue at the level of
foramen caecum.
Continues as thyroglossal
TGD disappears in 5-6th wk
Small isoechoic mass in superior
aspect of the left thyroid lobe

Same echoes as surrounding gland

Pyramidal lobe
 Ectopic/ Lingual thyroid

Thyroid scintigraphy
MC: above hyoid bone b/w foramen caecum
and epiglottis in midline
 Thyroglossal cyst

 Cystic mass with low

level internal echoes
 Midline between

isthmus and hyoid

 Thyroid nodules
 Incidence: directly correlated
with age (~Age minus 10)
 10-13% of nodules: CA

MC lesion: Hyperplastic nodule

Or colloid / adenomatous nodule
Etiology: idiopathic/ iodine
deficiency/ disorders of hormone
Multinodular goitre

Multiple nodules of
variable echogenicity are
seen scattered in an
enlarged thyroid gland
 Cystic components with
septations in a benign
goiterous nodule
 Ring down / comet tail
sign from bright foci in a
mixed solid and cystic
colloid nodule,
representing inspissated
 Peripheral "egg shell"
calcification surrounding
the nodule
 Follicular adenoma
 Well-marginated
hypoechogenic nodule
 Surrounded by a
hypoechogenic halo
 Papillary thyroid cancer FNAC done

 Hypoechoic poorly
marginated solid lesion.

Complex lesion, solid with

internal cystic components.
 Papillary thyroid cancer

 Metastatic jugular
lymphadenopathy with
microcalcifications and
cystic changes
Differentiation of Thyroid Nodules by sonographlc characteristics

Benign characteristics Malignant characteristics

Simple cysts
Cystic components Solid
Hyperechogenic/lsoechogenic Hypoechogenic
Gross calcifications/Eggshell calcification Microcalcifications
Thin peripheral halo No halo or thick peripheral halo
 Hashimotos thyroiditis
 Chronic immune
lymphocytic thyroiditis
 Hypothyroidism

 Increased risk for thyroid

Heterogenous echotexture. Scattered tiny
lymphoma hypoechoic nodules. Increased vascularity.

Diffusely hypoechoic heterogeous gland,

with hyperechoic fibrous strands.
 End stage of Hashimotos
 hyperechogenic atrophic
 Graves disease
 Hyperthyroidism-MCC

 Diffusely enlarged,
hypoechoic gland with
extremely increased
 Thyroid inferno
 Subacute granulomatous
thyroiditis (de Quervain's
 Diffusely enlarged
hypoechoic heterogeneous
gland, with poorly defined
areas of hypoechogenicity
in both lobes of the thyroid
 Usually four, two upper,
located behind the middle
portion of the each thyroid
lobe, and two lower,
behind and just inferior to
the lower poles of the
thyroid gland
 Oval in shape
 1*3*5 mm in diameter
 almost never seen with
ultrasound unless enlarged.
 Primary and secondary

 Primary :
Solitary parathyroid adenoma – 85%
Multiple gland adenoma or hyperplasia – 15%
Carcinoma - 1%
 Parathyroid adenoma

 Large solid hypoechoic

parathyroid adenoma of the
upper parathyroid gland
 Ectopic adenoma(3%):
retrotracheal and
retroesophageal, in the lower
neck and mediastinum, in
the carotid sheath and
intrathyroid • Hypervascular, posterior to the thyroid
• a linear interface between the adenoma
and the thyroid gland
 Parathyroid Adenoma in
the sheath of the common
carotid artery
 combination of
sonography and
scintigraphy with

Technetium 99-m sestamibi

scintigraphy: Delayed (120') image
shows persistent uptake in the PTA
and show out in the thyroid gland
 Composed of lymphoid
follicles located in the
outer cortex and lymphatic
channels, blood vessels and
connective tissue, in the
inner medulla
 Normal Lymph nodes
 oval-shaped structure

 long/short axis ratio 1.5-2

 hypoechogenic cortex

 echogenic hilum

 central vascularity
 Reactive LA
 Oval-shaped lymph node

 thickened homogenously
hypoechogenic cortex
 larger than 5 mm in short
 preserved echogenic hilum

 central increased
 Malignant LA
 Round-shaped

 enlarged, very hypoechoic

 Long-short axis ratio less
than 1.5
 Absent echogenic hilum
 Peripheral vascularity
 Cystic changes,
Carotid bifurcation

 Parotid Gland
 smaller deep part and a
Ramus of Mand
larger superficial part,
both of which are
continuous around the
posterior aspect of the
Facial N
ramus of the mandible via ECA and Post
the isthmus fac V

 Parotid gland
 oval, medium echogenic,
well delimitated structures
 Submandibular Gland
 medial to the angle of the
 mixed mucinous and
serous gland-tendency to
form calculi
 lower superficial lobe
continuous with a smaller
deep lobe above around
the posterior border of
the mylohyoid muscle
 Submandibular gland
 Wharton ’ s duct
• about 5 cm long
• commences as a confluence
of several ducts in the
superficial (lower) lobe
• runs superiorly through the
deep (upper) lobe before
running forward in the floor
of the mouth
• open at the side of the
frenulum of the tongue
 Submandibular gland

1-sup sub
2- deep sub
3- mylohyoid
4- duct
5- facial v
L 6- digastic

 Intraductal stone.
 echogenic structure
casting an acoustic
shadowing associated with
an enlarged duct is seen in
the submandibular salivary
 Parotid pleomorphic
 A large, homogeneous
hypoechoic mass is seen in
the parotid gland.
 Parotid Warthin's
 A large, heterogeneous
mass is seen in the parotid