PAPILLON COURSE on THYROID ULTRASOUND

1. How would you consider the echogenicity of the nodule in the right lobe?

Distribution of answers

2 Iso/hyperechoic

30 Minimally/moderately hypoechoic

12 Very hypoechoic

Expert comment

The nodule is either minimally/moderately hypoechoic or very hypoechoic because it is clearly darker than the extranodular tissue. There are some very hypoechoic parts within, however the dominant or average echogenicity is minimally/moderately hypoechoic.

2. What intranodular echogenic figures does the lesion have?

Distribution of answers

14 Back wall figures

5 Comet tail artifacts

24 Punctate echogenic foci which can be microcalcifications

15 Obvious forms of microcalcifications

Expert comment

The pale echogenic lines and granules correspond to the normal architecture of the nodule and the thyroid. These can be found even outside the nodule. These resemble back wall figures but are not dorsal to cystic areas. So, the real question is the origin or the bright echogenic figures. Some of them are located dorsal to tiny cystic areas, e.g., the echogenic lines in the dorsal third of the nodule at 0:32 to 0:34 in the video, so back wall figures are present.
The three or four bright granules in the lower-medial part of the nodule are challenging. When I prepared the case study a few years ago, I stated that these are obvious forms of microcalcifications. Now, I am not entirely sure about this. So, I think both last 2 answers can be accepted.

3. How would you judge the nodule borders?

Distribution of answers

4 Sharp and regular

1 Blurred

19 Blurred and irregular

20 Irregular

Expert comment

I consider the nodule borders as irregular but not blurred. The pathological undulations, therefore, the irregular margins are evident. Although some parts of the borders are not well defined, but blurred, I won't consider the degree as pathological.