Clinical data: An 81-year-old man came to a follow-up. Ha has been known harboring an enlarged, multinodular goiter for more than 15 years. Recently, he occasionally felt neck discomfort in supine position.

Palpation: The left lobe was enlarged and had multiple nodules. The lowest one was firm.

Laboratory tests: TSH 0.92 mIU/L.

Ultrasonography. The right lobe was echonormal and had several moderately hypoechoic discrete lesions. The left lobe was composed of multiple nodules. The largest one in the lower third was dominantly hypoechoic, heterogeneous nodule. Compared with the previous examination, both the left lobe and the heterogeneous, large nodule had increased in size. AT the level of the largest nodule, the trachea was narrowed to 11 mm.

Cytology was performed form the lesion in the lower third of the left lobe and resulted in follicular proliferation, Bethesda III category.

Surgery was advised. At the same time, he still wanted to wait with the operation.

Comments.

1. It is worth comparing the influence of the focus' setting on the image quality.

2. The lower pole of the lobe was not visible even while the patient swallowed which meant that the left lobe spread substernal. Nevertheless, the degree of substernal extension was judged as not very high - see images.

3. We can measure the diameter of the trachea in the neck. In this case a substantial narrowing was found.