First examination (first row of images)

Clinical presentation: A 64-year-old woman was referred for ethanol sclerotherapy. The patient has been aware of a slowly growing nodule for more than 20 years. The patient has suffered from cough and difficulties in swallowing for several months. These complaints were resolved after aspiration of 30 mL cystic fluid which has been performed for 3 weeks. However, the cyst has refilled within 2 days and her complaints have recurred. She had various diseases including ischemic heart disease, recurrent thrombotic events, therefore general anesthesia would share a significant risk.

Palpation: a large hard nodule occupied the right lobe and the isthmus.

Functional state: euthyroidism (TSH 1.05 mIU/L).

Ultrasonography. The thyroid was echonormal. A large mixed nodule was found in the right lobe. The solid part of the lesion was echonormal, and the nodule presented signs of a type 2 vascular pattern.

27 mL cystic fluid was aspirated, thereafter 7.2 mL absolute alcohol was administered. The patient had no significant complaints.

Six more courses of percutaneous ethanol injection were applied.

Follow-up investigation eight month later (second row of images)

Clinical data. The patient had no complaints.

Palpation: The nodule in the right lobe was significantly smaller compared with first examination.

Functional state: euthyroidism (TSH 0.96 mIU/L).

Ultrasonography. The thyroid was echonormal. The nodule was composed of multiple echonormal discrete lesion and lacked cystic fluid. The volume was 1/8 of the pretreatment size.

Suggestion: yearly follow-up.