PAPILLON COURSE on THYROID ULTRASOUND

Section 2 The nodular goiter

Part 2 Composition of the nodule
Lectures

 

Table 2 The role of emptying the cyst

The aspiration of the cystic fluid frequently changes the appearance either of the entire nodule or the echogenicity of the solid part. The removal of cystic content can make the nodule' borders irregular. As a rule, the composition and the borders of the nodule should be defined before the aspiration while the echogenicity and the subtype of the nodule is much better to determine after the aspiration.

 

Papillary carcinoma (histology) - case 1457

Before the aspiration
After the aspiration

This case illustrates the essence of the categorization of a cystic thyroid lesion. This small cyst seemed to be a pure cyst before the aspiration, because no solid part could be detected. The presence of the solid part became evident only after aspirating the cystic fluid. The solid part contained microcalcifications. Although the risk of malignancy is less in the event of a seemingly pure cyst, the aspiration of such lesions seems to be not superfluous in certain cases. We perform aspiration if the lesion is larger than 10-15 mm.

   

Benign nodule (cytology) - case 956
Before the aspiration
After the aspiration

On the presence of wall thickening (left upper image) the nodule should not be regarded a pure cyst. The almost completely cystic lesion proved to be a central type cyst after the aspiration of cystic content.

 
Benign cystic nodule - case 1139
Before the aspiration
After the aspiration

The aspiration of the cystic content frequently alters the borders of a cystic nodule, i.e. the borders can become irregular, as in this case. It is worth noting this change in the ultrasound report.
   
Benign cystic nodule - case 296
Before the aspiration
After the aspiration

An almost completely cystic nodule proved to be a central-type cystic lesion after the aspiration. The emptying led to the borders becoming irregular.
 
Benign cystic nodule - case 420
Before the aspiration
After the aspiration

In this case, the aspiration did not lead to change in ultrasound presentation.
 
Benign cystic nodule - case 662
Before the aspiration
After the aspiration

The nodule' borders became irregular after the aspiration of the cystic content.
   
Benign cystic nodule - case 1473
Before the aspiration
After the aspiration

This nodule seemed to be a projecting type, peripheral lesion before aspiration because the thin solid part was not visible all along the wall of the nodule while it came into sight after evacuation; therefore this nodule belongs to central cystic type.
 
Benign cystic nodule - case 1604
Before the aspiration
After the aspiration

The lesion seemed to be an almost completely (pure) cyst before aspiration. After aspiration of 20 mL fluid it became evident that the nodule has a moderately solid area and it was indeed a central-type cystic nodule.
   
Benign cystic nodule - case 1275

It is equivocal before the aspiration whether this is a peripheral or central type cyst. After the removal of 14 mL brown cystic fluid it became evident that this was a central-type cystic nodule. The aspiration has led to two important changes. First, the solid part became more hypoechogenic and the borders of the nodule became irregular, spiculated and lobulated.

   
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