Papillary carcinomas - Figure 20. Sonographic signs - microcalcification.

Microcalcification is the second most important ultrasound sign of papillary carcinoma. This property increased the risk of being the nodule malignant 6.4-fold in our patients. High number of microcalcifications, i.e. the so-called starry sky appearance is almost diagnostic for papillary carcinoma (first and second row of images) . On the other hand smaller number of bright hyperechogenic foci has much less significance. Moreover, in such cases even the origin of hyperechogenic granules may be doubtful. Fibrotic changes and comet-tail artifact have to be considered, as well.