Parathyroid & Other Neck Pathology

the most common cause of enlargement of a parathyroid gland

parathyroid adenoma

if a patient has elevated serum calcium (hypercalcemia), analyze the neck carefully for signs of a

parathyroid adenoma

clinical findings of a parathyroid adenoma

1. elevated serum calcium

2. elevated PTH

sonographic findings of a parathyroid adenoma

1. hypoechoic mass adjacent to the thyroid

enlargement of the cervical lymph nodes, or —

lymphadenopathy

lymphadenopathy usually measure less than —

1 cm

clinical findings of abnormal lymph nodes

1. palpable neck mass (possibly)

2. enlarged nodes may be painful

sonographic findings of abnormal lymph nodes

1. enlargement of the node >1 cm

2. rounded shape

3. loss of the echogenic hilum

4. calcifications

5. may be hyperemic or demonstrate abnormal vascular patterns with color doppler

thyroglossal duct cysts are

benign congenital cysts located within the midline of the neck superior to the thyroid gland and are typically located below the level the hyoid bone

brachial cleft cysts are

congenital neck cysts as well

brachial cleft cysts are most often found near the

angle of the mandible

fibromatosis colli is a rare,

pediatric fibrous tumor located within the sternocleidomastoid muscle

the likely cause of fibromatosis colli

malposition in utero or a traumatic birth that leads to the development of fibrosis (scar tissue) within the muscle

congenital muscular torticollis

the mass within the sternocleidomastoid muscle causes the muscle to shorten, resulting in teh twisting of the infancts chin toward the nonaffected side

clinical findings of a thyroglossal duct cyst

1. palpable mass within the midline of the neck superior to the thyroid gland

2. infected cysts may be painful

sonographic findingd of a thyroiglossal duct cyst

1. anechoic, well-defined, and unilocular cyst with posterior enhancement

2. may have internal components

clinical findings of a branchial cleft cyst

1. palpable neck mass located near the angle of the mandible

2. infected cysts may be painful

sonographic findings of branchial cleft cyst

1. anechoic mass near the angle of the mandible

clinical findings of fibromatosis colli

1. pediatric palpable neck mass

2. torticollis (twisted neck with the chin angled to the nonaffected side

sonographic findings of fibromatosis colli

1. fusiform-shaped mass within the sternocleidomastoid muscle that is hypoechoic, hyperechoic, or even isoechoic to the adjacent tissue

2. may also contain calcifications that shadow

3. may yield a hyperemic pattern with color doppler

low risk thyroid cancer

intermediate risk thyroid cancer

high risk thyroid cancer

Nuclear medicine images of thyroid nodules. A radioactive marker (Mrk) was placed over a 2-cm palplable nodule (arrow) in the right thyroid lobe. This nodule represents a “hot” nodule, which is most likely benign.

Abnormal lymph node. This lymph node is enlarged, hypoechoic, and has lost its echogenic hilum.