Clinical presentation: A 70-year-old woman has been followed for a thyroid nodule for 13 years. Cytology had resulted two-times in benign lesion. Two months before the present examination she was treated for hypertensive crisis in another hospital and she was told to harbor a very suspicious lesion in her thyroid which requires surgical removal irrespectively of cytological result.

Palpation: a not firm nodule in the right lobe.

Functional state: euthyroidism with TSH 1.37 mIU/L.

Ultrasonography. The thyroid was echonormal. There was a partially cystic nodule having an echonormal solid part in the right lobe. The lesion presented various hyperechogenic figures including comet-tail artifacts and ambiguous ones. The nodule did not grow in the past 13 years.

Aspiration cytology of the upper lesion resulted in benign cystic-colloid goiter.

Comments.

1. The nodule has equivocal echogenic granules. These are as bright as the comet-tail artifacts which are also present. It means that the ambiguous figures might be also colloid crystals though the possibility of punctate echogenic foci (microcalcifications) cannot be excluded.

2. This case does not belong to the exceptional cases in which we have to indicate surgery solely on the ultrasound presentation.