Clinical presentation: A 46-yr-old woman was referred for evaluation of a nodular goiter discovered on screening.

Palpation: The right lobe was suspicious having a nodule.

Laboratory test: TSH 0.93 mIU/L.

Ultrasonography. The right lobe was echonormal. There was a hypoechoic lesion in the right lobe. The mass had irregular margins. However, it was equivocal whether this was of pathological reasons or caused simply by the presence of multiple nodules next to each other.

Cytology resulted in benign follicular proliferation.

Comments.

1. Occasionally, we cannot decide whether a lobulation is of pathological or of non-pathological cause. This nodular area has lobulated margins. On the other hand, it is equivocal whether the nodular area is composed of one or more discrete lesions. In the former case this would belong to TIRADS 5 category and would require cytological evaluation. If we consider that there are two or more nodules, than the most suspicious, ventral moderately hypoechogenic nodule is a TIRADS 4 category lesion and FNA would not be indicated based on the ETA TIRADS, because the maximal diameter is less than 15 mm.
   
2. The lesion had ill-defined ventral borders only on longitudinal scan. This was caused by the improper fitting of the transducer to the neck of the patient. The anatomy makes not infrequently impossible a proper fitting of the probe.