Benign, cystic-colloid goiter (cytology) - case 2128 |
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Right lobe, transverse scan. The ratio of the distance between arrowheads (which point to the arch of the abutting part) to the distance between the arrows (which is the diameter of the nodule) is around 90%. According to the rule of geometry, the perimeter abutting is the half of this ratio, i.e. around 45%.
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The lesion presents less than 25% of tumor perimeter contact with the adjacent capsule. The ratio of the distance between arrows to the distance between arrowheads is more than the double of this value because the shape of the lesion is not of regular geometrical.
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The dorsal contour is non-abutting between the green and red arrows while abutting between the green and yellow arrows. In the former area, there is a thin echonormal parenchyma between the dorsal surface of the nodule and that of the lobe.
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There is a thin echonormal parenchyma ventral to the nodule, therefore the nodule presents no or only minimal perimeter abutment in the ventral part. Yellow arrows point to those parts of the nodule' surface where the borders are indistinctive, while red arrows do to those areas where halo is present.
On the other hand, the nodule at the dorsal part is adjacent to the thyroid capsule, but the perimeter abutment is less than 25%.
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Sclerotherapy of a benign cystic nodule - case 2068 |
Before the second session of sclerotherapy |
Four years after the sclerotherapy |
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Initially, the nodule presented non-abutting contour because there was a thin echonormal parenchyma between the ventral surface of the nodule and the thyroid. At the follow-up, the contour became abutting. The capsule was non-visible at the first, while became discontinuous at the follow-up examination.
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Transverse scan |
Longitudinal scan |
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The hyperechogenic line on the ventral surface of the lobe is all along intact in the transverse scan, while the more complex echogenic structure running in the ventral surface of the lobe (longitudinal scan) is not broken. The nodule' contour is abutting.
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A patient with after aspiration of a benign cyst - case 2062 |
Before the aspiration |
After the aspiration |
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At first sight, the pattern seems to be suspicious of extrathyroidal spread. In the upper left image, the origin of the ventral wing-like hypoechogenic structure is equivocal. Considering the right upper image, the run of the strap muscle is more evident. The dorsal wall of the strap muscle is marked with yellow arrows. Nevertheless, the ventral wall of the hypoechogenic nodule is in direct contact with the muscle fiber.
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The cyst before the aspiration
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There is an area where we cannot separate the strap muscle from the cystic nodule. This is caused simply by a technical artifact: be aware that we can follow an acoustic artifact (marked with red) up to the most ventral part of the image.
On the other hand, this case meets all criteria on which extrathyroidal spread should be considered: abutment, protrusion of the nodule into the adjacent tissue (i.e. capsular bulging) and disruption of the capsule (green arrows).
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