Clinical data: A 47-year-old woman was referred for aspiration cytology. The patient underwent total thyroidectomy followed by radioiodine therapy because of a T2N1a papillary cancer. Two 15-mm large foci were found, one in the right and the other one in the left lobe. The surgery was performed 13 months ago, while the second radioiodine was 4 months before the present examination. On routine follow-up, the thyroglobulin proved to be elevated.

Palpation: no abnormality.

Laboratory test: thyroglobulin 3.85 microgram/L.

Ultrasonography. The right lobe was replaced with connective tissue. A hypoechoic mass was found in the left thyroid bed. On certain sections, this mass was very similar to a muscle fiber, however some other sections proved the presence of intralesional echogenic figures; the presence of back wall cystic figures was obvious but in the event of some granules microcalcifications should be considered. The lesion was vascularized, which excluded that the mass is muscle fiber.

Cytology resulted in papillary cancer.

Comments.

1. At first sight, the pathological node could be a muscle fiber. However, it had an oval shape and presented with significant amount of vascularity. These clearly stood against being the lesion a muscle fiber.

2. It is worth comparing the presentations of the lymph node with different settings. The node had indeed minimal if any cystic portions. However, with better harmonization, the node deceptively seemed to contain great amount of fluid.

3. On transverse scan, even with less harmonic settings, the node seemed to have significant amount of fluid. This can be explained by the fact that it was much mor difficult to place the transducer to the neck of the patient in transverse scan because the Adam's apple hindered the correct placement. In longitudinal scan, the positioning of the probe was more adequate.