Clinical presentation: A 69-yr-old man was referred for evaluation of multinodular goiter detected on carotid Doppler examination. A TIRADS 5 hypoechoic nodule which had microcalcifications and showed lobulated margins and taller-than-wide shape was described by the radiologist.

Palpation: The right lobe had not firm nodules.

Laboratory tests: TSH 1.38 mIU/L.

Ultrasonography. The thyroid was echonormal. There were multiple nodules in the right lobe including a hypoechoic one. It had intranodular echogenic lines and granules related to ventral cystic areas, which means that the figures were caused by back wall posterior enhancement. Just medial and lower to the hypoechoic lesion, there was a another, less hypoechoic nodule. Thorough analysis revealed that the close proximity of the larger nodule made the shape of the hypoechoic nodule deceptively suspicious because it hindered the medial and lower extension of the hypoechoic lesion. Consequently, both the width and the length proved be higher.
The nodules in the right lobe presented with different vascular patterns, the hypoechoic had intranodular, while the two more echogenic have perinodular blood flow.

Cytology resulted in benign, cystic-colloid goiter.

Comment. In my opinion, this is a very edifying case. It may worth analyzing the video and the still images with explanation even several times in order to realize and to understand the real situation which caused a deceptive presentation.