PAPILLON COURSE on THYROID ULTRASOUND

Part 5 Borders of the nodule
Lectures

This case illustrates the difference between pseudo-lobulation caused by the presence of multiple discrete lesions located next to each other and the true, pathognomonic lobulation. Red arrows point to different lesions causing a lobular appearance, while yellow arrows point to pathological protrusions in the margin of a single lesion.

Occasionally, it is difficult or even impossible to judge whether a lobulated surface is caused only by the presence of multiple discrete lesions or certain parts of a lesion are in fact pathologically lobulated. The clue is the thorough analysis of video. In this case, pathological lobulation is not likely.

In this case, the lobulation is not pathological, this is caused by the presence of multiple lesions next to each other.

The middle, malignant nodule has partly blurred (yellow arrows), partly lobulated margins (white arrows) while the lower, benign nodule presents blurred borders (yellow arrows) and spiculated margins (red arrows), as well. The small irregularities marked with green arrows cannot be judged as pathognomonic for lobulated margins.

A large isoechoic lesion occupied the upper 3/4 of the right lobe. This lesion can be seen in the longitudinal scan. The hypoechoic nodule in the lower part presents typical lobulated margins.

The dorsal and medial borders of the nodule is partly ill-defined partly lobulated.

The nodules present different types of non-regular borders. White arrows point to spiculated margins, red arrows do to lobulated margins while yellow ones do to blurred borders. The origin of the spiculations on the surface of the hypoechogenic nodule (green arrows) is equivocal, these might be caused by the impression of the echonormal lesion on the surface. The upper, malignant nodule has microcalcifications while the lower benign one presents both taller-than-wide and longer-than wide sign.

In this case almost the entire border of the nodule is ill-defined, moreover the lesion has lobulated (yellow arrows) and spiculated (red arrows) margins, as well.

This nodule has clearly lobulated margins.

The hypoechogenic tail marked with yellow arrows corresponds either to lobulated or spiculated margin.

This is a typical presentation of lobulated margins.

The border of the nodule presents small irregularities marked with red arrows. The interpretation of these small protrusions might be equivocal. There is one large clearly pathological lobulation marked with yellow arrow.

The interpretation of the borders is not evident in this case. The issue is whether this hypoechogenic lesion is one large heterogeneous nodule or is composed of multiple discrete nodules. In the former case, the nodule unequivocally has lobulated margins, while in the latter case the presence of pathological lobulations is doubtful. In my opinion, this hypoechogenic mass is more likely being one large nodule with heterogeneous echogenicity and therefore presents lobulated margins.

The nodule has partly blurred, partly lobulated margins.

The tumor presents lobulated margins.

The nodule has lobulated margins.

The hypoechoic lesion has irregular spiculated, lobulated margins and presents blurred borders.