Unit 1 TI-RADS/Thyroid Biopsy/Miscellaneous Neck Masses

What does TI-RADS stand for?

Thyroid Imaging Reporting and Data System

TI-RADS

5 nodule characteristics are evaluated and scored to assign a malignancy risk value

What are the 5 characteristics?

1. composition

2. shape

3. echogenic foci

4. echogenicity

5. margins

With Partially Cystic Nodules, you want to evaluate the?

solid component characteristics

What are the suspicious features of Partially Cystic Nodules

eccentricity or irregular borders

punctate echogenic foci

lobulation

What are the considerations?

-report only 4 nodules in the gland

-recommend FNA for no more than 2 nodules with the highest TI-RAD score

-extenuating circumstances such as prior history or lymph node characteristics may modify the recommendations

What is the composition?

-solid= 2 points

-mixed cystic and solid= 1 point

-cystic = 0 points

-spongiform= 0 points

can’t tell= 2 points

What is this image showing?

spongiform

What is this image showing?

pseudo-spongiform

How do you break up echogenicity?

hyperechoic and isoechoic= 1 point

hypoechoic = 2 points

very hypoechoic = 3 points

can’t tell = 1 point

Thyroid fine needle aspiration biopsy is a very ________ ________, but it does carry some slight risks

safe procedure

What are the risk factors associated with FNA

-bleeding

-infection

-damage to the thyroid

-inadequate sample

What are thyroglossal duct cysts?

-congenital

-remnant of tubular development between the tongue and hyoid bone

Failure of atrophy of duct=

potential cystic mass

Thyroglossal Duct Cysts are……

midline of anterior neck

oval 2-3 cm

What is this image showing?

thyroglossal duct cyst

What are branchial cleft cysts?

tract extending from the pharyngeal cavity to the opening neat auricle

Diverticulum may develop:

lateral from pharynx or medial from neck/ auricle insertion

Primarily cystic

may have low level echoes= infection

Cystic Hygroma are…….

congenital

-modification of the lymphatics

-posterior occiput origin

-cystic mass to lateral sides

multiseptated

multilocular

Abscess can occur at…….

any location

What is the sonographic appearance of abscess?

-fluid-filled to completely echogenic

-more chronic - more difficult to distinguish

-localization for aspiration by US

What is lymphadenopathy

lymph node enlargement

>1cm diameter

What is the sonographic appearance of lymphadenopathy?

-hypoechoic to anechoic

-oval to elongated

-may have an echogenic rim appearance

-echogenic central area

-evaluate blood flow

What is this image showing?

lymphadenopathy

Where is the carotid body tumor located?

posterior aspect of carotid bifurcation

tumors are slow growing and rare

What is the size of Carotid Body Tumor

3-5 mm normally

What is chemoreceptor?

assists in regulation of heart rate, blood pressure, respiration

What is the sonographic appearance of the carotid body tumor?

-hypervascular

-lies between ICA and ECA

What is this image showing?

a Carotid Body Tumor

What is this image showing?

carotid body tumor

What Ectopic Thyroid Tissue

-small mass of thyroid tissue

-located separately from the thyroid

-echotexture same as thyroid