Clinical presentation: A 49-yr-old woman was referred for follow-up evaluation of a nodular goiter, which has been diagnosed for 7 years. Cytology resulted in benign lesion at the time of the recognition of the nodule.

Palpation: no abnormality.

Laboratory test: TSH 2.51 mIU/L.

Ultrasound. The thyroid was echonormal. There were two hypoechoic nodules in the right lobe. The middle had macrocalcification and was suspicious containing microcalcifications, as well. The lower, dominantly hypoechoic, heterogeneous lesion showed hyperechoic granules, which were more probably back wall cystic figures caused by posterior enhancement than punctate echogenic foci (microcalcifications).

Aspiration cytology was performed from both nodules and resulted in benign and non-diagnostic report, middle and upper lesions, respectively.

Comments. This is an example of non-pathological blur caused by the dorsal acoustic shadow of a macrocalcification.