Clinical presentation: A 43-yr-old woman was referred for evaluation of a dysphagia. She has had a severe familial issue for a few months. Her complaints started during this period.

Palpation: no abnormality.

Laboratory tests: TSH 0.93 mIU/L.

Ultrasonography. The thyroid was echonormal. On transverse scan, a minimally-moderately hypoechoic areas was found in the ventral part of the right lobe. Just ventral to this area, there was a thick connective tissue band within the strap muscle. This area could not be detected on longitudinal scan.

Comment. Anatomical structures ventral to the thyroid influence the penetration of ultrasound wave. The two most common examples are the acoustic shadowing caused by macrocalcifications and the opposite, the acoustic amplification dorsal to cystic fluid. In this case, the thickened connective tissue impaired the penetrance of ultrasound wave and decreased the echogenicity of the thyroid dorsal to this thickening.