Case of the month

March 2021 - case 2

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1. How to judge the intranodular echogenic figures in the largest discrete lesion of the LEFT lobe?

I agree with those who said that these figures are microcalcifications. I do not think that any of them can be considered as comet-tail artifacts.

2. What is the echogenicity of the largest lesion in the LEFT lobe?

The nodule has both minimally/moderately and deeply hypoechoic areas. By definition, such a nodule cannot be classified as heterogeneous because the latter must contain both iso/ hyperechogenic and hypoechogenic parts. Therefore, four colleagues I think were wrong. They stated that this is a heterogeneous nodule composed of minimally/moderately and deeply hypoechoic parts. The fifth colleague said the nodule is minimally/moderately hypoechoic nodule, I agree with this responder. The dominant part of the nodule is minimally/moderately hypoechoic.

3. How to classify the largest lesion in the LEFT lobe according to the EU-TIRADS?

One responder classified the lesion as Category 4 (intermediate risk) while 4 did as Category 5 (high risk). This is clearly a high suspicion lesion because of the presence of microcalcifications.

4. According to the EU-TIRADS, should the largest nodule in the RIGHT lobe be evaluated by FNA?

According to EU-TIRADS, a lesion less than 1 cm in maximal diameter is not an indication of FNA. None of the discrete lesions in the RIGHT lobe reached this size limit.

6. Which statement is correct regarding the RIGHT lobe?

Three colleagues were of that opinion that the lobe had both pathological nodules and discrete lesions of Hashimoto's thyroiditis while according to two responders, the discrete lesions were either more active foci of Hashimoto's thyroiditis or areas less influenced by the underlying thyroiditis. Histopathology disclosed no nodule in this lobe, so the latter two colleagues were right.

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