Thursday, March 5, 2009

Thyroid cyst with mural nodules


Patient History:
60 years old Malay female referred for thyroid scan with indication of mass noted at the centre region of the neck.The mass was palpable, non-mobile and was noted since 2 months ago. It was asymptomatic and painless. It does not interfere with swallowing.No other complaint made.Blood test was done on about one week ago but its result is not avalaible. No prior history and family history of having thyroid disease.No previous surgery done.

US Findings:
The indicated mass appeared as one oval anechoic cystic lesion at right lateral region of the isthmus. It has well-defined and regular border, with mural nodules seen. The size of the cystic lesion was 2.2cm x 1.8 cm x 1cm whereas the mural nodules were measured at about 0.7cm at posterior wall and about 1.4cm at anterior wall. No vascular flows noted. The thickness of the isthmus was still within normal range: 0.3cm.
For both left and right thyroid, the size remain normal (right lobe: 2.5cm x 1.6cmx 4.1cm; left lobe: 1.9cm x 1.9cm x 4.2cm). Parenchyma appeared fine and homogenous in echotexture but with multinodular multicystic changes. Two oval, well-defined heterogenous hpoechoic nodules were noted at upper pole of the right thyroid. The larger measured about 1cm and calcification was noted. For left thyroid,the most prominent nodule was noted at the lower pole of the left thyroid. It has heterogenous hypoechoic appearance and was measuring ~1.2cm. None of the vascularity of these nodules and cysts showed hypervascularity.
No retrosternal extension. Color Doppler assessment of both lobes showed normal vascularity. The cervical lymph nodes were not enlarged. No pathologies at adjacent soft tissue noted.
Impression:
1. Palpable mass was noted as one prominent cyst with mural nodule measuring about 2cm at right lateral part of the isthmus.
2. Multinodular and multicystic changes in both thyroid gland consistent with early multinodular goitre.

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