Neck and Salivary Glands

A congenital diverticulum of the brachial cleft located directly below the angle of the mandible.

Brachial cleft cyst

Bulging of the eyeballs

Exophthalmos

Exophthalmos (bulging of the eyeballs) is associated with _____.

Hyperthyroidism

Subacute thyroiditis secondary to a viral infection.

De Quervain syndrome

A pronounced swelling of the neck caused by an enlarged thyroid gland.

Goiter

A multisystemic autoimmune disorder characterized by pronounced hyperthyroidism; usually associated with an enlarged thyroid and exophthalmos.

Graves disease

A progressive autoimmune inflammatory disorder of the thyroid gland; most common cause of hypothyroidism; associated with an increased risk of developing a thyroid malignancy.

Hashimoto disease

What is the most common cause of thyroid enlargement in children and hypothyroidism in adults?

Hashimoto disease

An excessive amount of calcium in the blood; associated with hyperparathyroidism.

Hypercalcemia

Hypercalcemia is associated with ______.

Hyperparathyroidism

Excessive function of the parathyroid glands; may lead to osteoporosis and nephrolithiasis.

Hyperparathyroidism

Hyperactivity of the thyroid gland; associated with Graves disease.

Hyperthyroidism

Graves disease is associated with _____thyroidism.

Hyperthyroidism

A deficiency of calcium in the blood; associated with hypoparathyroidism.

Hypocalcemia

Hypercalcemia is associated with _____.

Hypocalcemia is associated with _____.

Hyperparathyroidism

Hypoparathyroidism

A condition of insufficient secretion of the parathyroid glands; associated with hypocalcemia and primary parathyroid dysfunction.

Hypoparathyroidism

Decreased activity of the thyroid gland; associated with Hashimoto disease.

Hypothyroidism

Neck muscles located on the anterior surface of the vertebral column, between the atlas and the 3rd thoracic vertebra; commonly associated with whiplash injuries.

Longus colli muscles

The most severe form of hypothyroidism; characterized by swelling of the hands, face, and feet; may lead to coma and death.

Myxoedema

Myxoedema is characterized by swelling of the ____, ____, and ____.

Hands, face, and feet

Myxoedema is the most severe form of _____.

Hypothyroidism

A transient thyroiditis seen following pregnancy.

Postpartum thyroiditis

Lateral and superficial neck muscles that attach to the sternum, clavicle, and the mastoid process of the temporal bone; act to flex and rotate the head.

Sternocleidomastoid muscles

A group of long and flat muscles located anterior and lateral to each thyroid lobe; includes the sternohyoid, sternothyroid, and omohyoid muscles.

Strap muscles

What are the 3 strap muscles?

Sternohyoid, sternothyroid, and omohyoid

An embryonic remnant cyst located between the isthmus of the thyroid and the tongue.

Thyroglossal cyst

Function of the Thyroid Glands:

-Maintain body ____, ____, and ____

-_____ is processed to manufacture, store, and secrete hormones: ____, ____, and ____

-Secretion of thyroid hormones is primarily controlled by the _____ hormone produced by the _____

-Functions to control the _____

-Maintain body metabolism, growth, and development

-Iodine is processed to manufacture, store, and secrete hormones: thyroxine (T4), triiodothyronine (T3), and calcitonin

-Secretion of thyroid hormones is primarily controlled by the thyroid-stimulating hormone produced by the pituitary gland

-Functions to control the basil metabolic rate (BMR)

Function of the Parathyroid Glands:

-Maintain homeostasis of blood _____ concentrations

-Secretes _____

-Maintain homeostasis of blood calcium concentrations

-Secretes parathormone

Function of the Salivary Glands:

-_____ glands that secrete enzymes as saliva to aid in mouth _____, _____, maintain _____ integrity, and _____ activity

-Exocrine glands that secrete enzymes as saliva to aid in mouth lubrication, digestion, maintain tooth integrity, and antibacterial activity

Function of the Carotid Arteries:

-Supply blood to the _____ and _____

Head and neck

Function of the Jugular Veins:

-Drain blood from the _____ and _____

Head and neck

Muscles of the neck - Longus colli muscles:

-Located on the _____ surface of the vertebral column

-Lie adjacent to the ____ and _____ to the thyroid lobe and CCA

-May be mistaken for an enlarged _____

-Located on the anterior surface of the vertebral column

-Lie adjacent to the trachea and posterior to the thyroid lobe and CCA

-May be mistaken for an enlarged parathyroid gland

Muscles of the neck - Platysma Muscles:

-Superficial muscles located in the _____ neck

-Located _____ to the subcutaneous tissues

Lateral

Posterior

Muscles of the neck - Sternocleidomastoid Muscles:

-_____ and _____ neck muscles

-Located _____ to the thyroid lobes, sternohyoid muscle and sternothyroid muscle

-Lateral and superficial neck muscles

-Located lateral to the thyroid lobes, sternohyoid muscle and sternothyroid muscle

Muscles of the neck - Strap Muscles:

-A collective group of long flat neck muscles

-Located _____ and _____ to the thyroid gland

Include the:

-Sternothyroid - located directly _____ to the thyroid gland

-Omohyoid - located _____ to the sternothyroid muscles

-Sternohyoid - located _____ to the sternothyroid muscles

-A collective group of long flat neck muscles

-Located anterior and lateral to the thyroid gland

Include the:

-Sternothyroid - located directly superficial to the thyroid gland

-Omohyoid - located lateral to the sternothyroid muscles

-Sternohyoid - located anterior to the sternothyroid muscles

Common carotid arteries:

-Left originates from the _____

-Right arises from the _____

-Ascend the _____ aspect of the neck

-Lie _____ to the internal jugular vein and _____ to the thyroid lobe

-Course deep to the _____ muscles

-Typically, no _____

-Bifurcate into the _____ and _____ carotid arteries

-Left originates from the aortic arch

-Right arises from the innominate (brachiocephalic) artery

-Ascend the anterolateral aspect of the neck

-Lie medial to the internal jugular vein and lateral to the thyroid lobe

-Course deep to the sternocleidomastoid muscles

-Typically, no branches

-Bifurcate into the external and internal carotid arteries

External carotid arteries:

-Supplies the ____, ____, and ____ with blood

-Lies _____ and _____ to the ICA

-Multiple extracranial _____

-_____ is the first branch of the ECA

-Supplies the neck, scalp, and face with blood

-Lies anterior and medial to the ICA

-Multiple extracranial branches

-Superior thyroid artery is the first branch of the ECA

Internal carotid arteries:

-Main blood supply to the _____ and _____

-Lie _____ and _____ to the ECA

-Terminate at the _____

-No _____ branches

-_____ is the first branch of the ICA

-Main blood supply to the eyes and brain

-Lie posterior and lateral to the ECA

-Terminate at the circle of Willis

-No extracranial branches

-Ophthalmic artery is the first branch of the ICA

Vertebral arteries:

-Arise from the first segment of the _____

-Provide blood to the _____ brain

-Lie in the _____ neck, ascending through the _____ of the spine

-Left and right vertebral arteries join to form the _____ at the base of the skull

-Basilar artery terminates in the posterior aspect of the _____

-Multiple _____ branches

-Arise from the first segment of the subclavian artery

-Provide blood to the posterior brain

-Lie in the posterior neck, ascending through the transverse processes of the spine

-Left and right vertebral arteries join to form the basilar artery at the base of the skull

-Basilar artery terminates in the posterior aspect of the circle of Willis

-Multiple extracranial branches

Internal Jugular Veins:

-Receive the major portion of blood from the _____,_____, and superficial parts of the _____

-Course ______ to the carotid artery

-Unite with the _____ vein, forming the _____ vein

-Right and left innominate veins join, forming the _____

-Receive the major portion of blood from the brain, neck, and superficial parts of the face

-Course lateral to the carotid artery

-Unite with the subclavian vein, forming the innominate (brachiocephalic) vein

-Right and left innominate veins join, forming the SVC

External Jugular Veins:

-Receive blood from the exterior _____ and _____ parts of the face

-Located in the superficial fascia of the _____ neck

-Empty into the _____

-Receive blood from the exterior cranium and deep parts of the face

-Located in the superficial fascia of the lateral neck

-Empty into the subclavian vein

Vertebral Veins:

-Receive blood from the _____ brain and empty into the _____ vein

-Located _____ to the corresponding vertebral artery

-Receive blood from the posterior brain and empty into the brachiocephalic vein

-Located anterior to the corresponding vertebral artery

What is the largest endocrine gland in the body?

Thyroid gland

Anatomy of the Thyroid Glands:

-Largest _____ gland in the human body

-Divided into the right and left lobes with a connecting _____

-_____ lobe is usually larger than the _____

-Isthmus connects the _____ third of the thyroid lobes

-Consists of follicles, connective tissue, nerves, lymphatics, and stroma

-Covered by two layers of _____

-Largest endocrine gland in the human body

-Divided into the right and left lobes with a connecting isthmus

-Right lobe is usually larger than the left

-Isthmus connects the lower third of the thyroid lobes

-Consists of follicles, connective tissue, nerves, lymphatics, and stroma

-Covered by two layers of connective tissue

Vasculature of the Thyroid Glands:

-_____ arteries supply blood flow to the superior portion of the thyroid gland

-_____ arteries supply blood flow to the inferior portion of the thyroid gland

-Superior thyroid artery arises from the _____

-Inferior thyroid artery arises from the _____

-Superior, middle thyroid veins drain into the _____

-Inferior thyroid vein drains into the _____

-Superior thyroid arteries supply blood flow to the superior portion of the thyroid gland

-Inferior thyroid arteries supply blood flow to the inferior portion of the thyroid gland

-Superior thyroid artery arises from the ECA

-Inferior thyroid artery arises from the thyrocervical artery

-Superior, middle thyroid veins drain into the internal jugular vein

-Inferior thyroid vein drains into the innominate vein

Parathyroid glands:

Two paired, bean-shaped glands located _____ to the thyroid gland

Posterior

What are the 3 salivary glands?

Parotid

Submandibular

Sublingual

Salivary Glands:

-_____ glands divided into lobules with a hilum where branching blood vessels, ducts and nerves are present

Parotid gland

-_____ of the salivary glands

-Shaped like an _____

-Contains _____ duct (excretory duct)

-Only salivary gland that has intraparenchymal _____

Submandibular gland

-Produce 70% of _____

-_____ in shape

-Contains _____ duct

-Glandular processes may connect the submandibular gland with the parotid and sublingual glands

Sublingual gland

-_____ and oval in shape

-Contains _____ excretory glands

-Exocrine glands divided into lobules with a hilum where branching blood vessels, ducts and nerves are present

Parotid gland

-Largest of the salivary glands

-Shaped like an inverted pyramid

-Contains Stenson's duct (excretory duct)

-Only salivary gland that has intraparenchymal lymph nodes

Submandibular gland

-Produce 70% of saliva

-Triangular in shape

-Contains Wharton's duct

-Glandular processes may connect the submandibular gland with the parotid and sublingual glands

Sublingual gland

-Small and oval in shape

-Contains 8-20 excretory glands

Location - Esophagus:

-Located _____ to the left thyroid lobe and _____ to the trachea

Medial

Posterior

Location - Trachea:

-Forms the _____ border of the thyroid glands

Medial

Location - Thyroid Lobes:

-_____ and _____ to the corresponding CCA and IJV

-_____ and _____ to the SCM and strap muscles

-_____ to the longus colli muscle

-_____ to the trachea and esophagus

-_____ to the thyroid cartilage of the larynx

-Medial and anterior to the corresponding CCA and IJV

-Posterior and medial to the SCM and strap muscles

-Anterior to the longus colli muscle

-Anterolateral to the trachea and esophagus

-Inferior to the thyroid cartilage of the larynx

Location - Thyroid Isthmus:

-_____ to the trachea

-_____ and _____ to the CCA and IJV

-Anterior to the trachea

-Medial and anterior to the CCA and IJV

Location - Parathyroid Glands:

-_____ to the thyroid glands

-_____ to the longus colli muscles

-Posterior to the thyroid glands

-Anterior to the longus colli muscles

Location - Salivary Glands:

Parotid gland

-_____ to the ear near the ramus of the mandible

-_____ vein separates the superior and deep lobes of the gland

Submandibular gland

-Located beneath the anterior _____, inferior and lateral to the _____ muscle

Sublingual gland

-Located beneath the muscles of the _____, medial to the _____muscle and lateral to the _____ muscle

Parotid gland

-Anterior to the ear near the ramus of the mandible

-Retromandibular vein separates the superior and deep lobes of the gland

Submandibular gland

-Located beneath the anterior mandible, inferior and lateral to the mylohoid muscle

Sublingual gland

-Located beneath the muscles of the tongue, medial to the mylohoid muscle and lateral to the hypoglossal muscle

Congenital Anomalies - Pyramidal Lobe:

-Third lobe arising from the _____ portion of the _____

-Ascends to the level of the _____

-Appears in _____% of patients

-Begins to _____ in adulthood

-Appears _____echoic to the normal thyroid gland

-Third lobe arising from the superior portion of the isthmus

-Ascends to the level of the hyoid bone

-Appears in 10-40% of patients

-Begins to atrophy in adulthood

-Appears isoechoic to the normal thyroid gland

The following describes which congenital anomaly of the thyroid?:

-Thyroid consists of two distinct lobes

Absent Isthmus

Congenital Anomalies - Ectopic Parathyroid Gland Location:

-May be found near the _____ bifurcation or posterior to the _____

-May also be located retroesophageal, substernal, _____, or intrathyroid

-May be found near the carotid bifurcation or posterior to the carotid artery

-May also be located retroesophageal, substernal, submandibular, or intrathyroid

Size:

-Isthmus: ____ in height

-Thyroid glands (adult): ____ in length, ____ in height, and ____ in width

-Thyroid glands (pediatric): ____ in length, ____ in height, and ____ in width

-Isthmus: 0.2-0.6 cm in height

-Thyroid glands (adult): 4-6 cm in length, 1.3-1.8 cm in height, and 1.5-2 cm in width

-Thyroid glands (pediatric): 2-3 cm in length, 0.2-1.2 cm in height, and 1-1.5 cm in width

Size:

-Parathyroid glands: up to ____ in length, ____ in height, and ____ in width

-Parotid glands: up to ____ in length, and ____ in both height and width

-Submandibular glands: averages ____ in length

-Sublingual gland: up to ____ in length

-Parathyroid glands: up to 6 mm in length, 2 mm in height, and 4 mm in width

-Parotid glands: up to 7 cm in length, and 3.5 cm in both height and width

-Submandibular glands: averages 3.5 cm in length

-Sublingual gland: up to 2.5 cm in length

Sonographic Appearance:

-Thyroid lobes and isthmus appear as ____geneous solid structures demonstrating a medium-gray echo pattern with a surrounding thin ____echoic line

-Sternocleidomastoid muscle are _____ and oval in shape appearing ____echoic compared with the normal thyroid gland

-Strap muscles are _____ and ____echoic compared with the normal thyroid gland

-Longus colli muscles appear ____echoic compared with the normal thyroid gland

-Thyroid lobes and isthmus appear as homogeneous solid structures demonstrating a medium-gray echo pattern with a surrounding thin hyperechoic line

-Sternocleidomastoid muscle are large and oval in shape appearing hypoechoic compared with the normal thyroid gland

-Strap muscles are thin and hypoechoic compared with the normal thyroid gland

-Longus colli muscles appear hypoechoic compared with the normal thyroid gland

Sonographic Appearance:

-Parathyroid glands are flat, bean-shaped _____echoic structures located _____ and _____ to the thyroid lobes

-Salivary glands - ____geneous and ____echoic compared with the normal surrounding muscle. Degree of echogenicity depends on the amount of intraglandular _____ tissue

-Carotid arteries and jugular veins appear as ____echoic tubular structures demonstrating internal _____

-Parathyroid glands are flat, bean-shaped hypoechoic structures located posterior and medial to the thyroid lobes

-Salivary glands - homogeneous and hyperechoic compared with the normal surrounding muscle. Degree of echogenicity depends on the amount of intraglandular fatty tissue

-Carotid arteries and jugular veins appear as anechoic tubular structures demonstrating internal vascular flow

Thyroid Lab Values: Thyrotropin (TSH):

-Normal range _____ ng/mL

-_____ (TSH)

-Regulates thyroid hormone _____ and _____

-Secretion controlled by the ______

-Prolonged elevation is associated with _____ and _____

-Decrease in levels is the first indication of _____

-Normal range 3-42 ng/mL

-Thyroid-stimulating hormone (TSH)

-Regulates thyroid hormone secretion and production

-Secretion controlled by the anterior pituitary gland

-Prolonged elevation is associated with hyperplasia and thyroid enlargement

-Decrease in levels is the first indication of thyroid gland failure

Thyroid Lab Values: Thyroxine (T4)

-Normal range _____ ug/dL

-Stimulates consumption of _____

-Secreted by the _____ cells of the thyroid

-Controlled by _____

-100-200 mg of _____ must be ingested per week for normal thyroxine production

-Decreases associated with _____ and _____

-Normal range 4.5-12.0 ug/dL

-Stimulates consumption of oxygen

-Secreted by the follicular cells of the thyroid

-Controlled by thyrotropin (TSH)

-100-200 mg of iodide must be ingested per week for normal thyroxine production

-Decreases associated with thyroid disease and nonfunctioning pituitary gland

Thyroid Lab Values: Triiodothyronine (T3)

-Normal range _____ ng/dL

-Regulates tissue _____

-Decreases associated with _____

-Normal range 70-190 ng/dL

-Regulates tissue metabolism

-Decreases associated with Hashimoto thyroiditis

Thyroid Lab Values: Calcitonin

-Normal range <_____ pg/mL

-Lowers _____ and _____ concentration in the blood

-Inhibits _____

-Secreted by the _____ cells (____-cells) of the thyroid gland

-Elevation associated with _____

-Decreases are associated with _____ or _____

-Normal range <100 pg/mL

-Lowers calcium and phosphorus concentration in the blood

-Inhibits bone resorption

-Secreted by the parafollicular cells (C-cells) of the thyroid gland

-Elevation associated with medullary thyroid carcinoma

-Decreases are associated with surgical removal or nonfunctioning thyroid glands

Parathyroid Lab Values: Parathormone (PTH)

-Normal range _____ pg/mL

-Regulates _____ metabolism in conjunction with calcitonin

-Released in response to low extracellular concentration of _____

-Elevation associated with _____

-Normal range 12-68 pg/mL

-Regulates calcium metabolism in conjunction with calcitonin

-Released in response to low extracellular concentration of free calcium

-Elevation associated with hyperparathyroidism

Parathyroid Lab Values: Calcium

-Normal range _____ mg/dL

-Aids in the _____ of _____ through the cell membranes

-Elevation associated with ____, ____, and ____

-Levels exceeding _____ mg/dL can be life-threatening

-Decreases are associated with _____ or _____ of the parathyroid glands

-Normal range 8.5-10.5 mg/dL

-Aids in the transportation of nutrients through the cell membranes

-Elevation associated with hyperparathyroidism, hyperthyroidism, and malignancy

-Levels exceeding 14.5 mg/dL can be life-threatening

-Decreases are associated with nonfunctioning or surgical removal of the parathyroid glands

Hyperthyroidism:

-_____ of the thyroid gland

-Symptoms include nervousness, _____, tremors, constant _____, weight _____, _____ intolerance, _____, increased _____, and _____

-Causes include toxic _____, _____ disease, and _____

-If untreated, may lead to _____

-Sonographic appearance - normal or _____ ____geneous ____vascular thyroid gland

-Hyperactivity of the thyroid gland

-Symptoms include nervousness, exophthalmos, tremors, constant hunger, weight loss, heat intolerance, palpitations, increased heart rate, and diarrhea

-Causes include toxic adenoma, Graves disease, and trophoblastic tumors

-If untreated, may lead to cardiac failure

-Sonographic appearance - normal or enlarged heterogeneous hypervascular thyroid gland

Hypothyroidism:

-Inadequate production of _____ and _____

-Symptoms include weight _____, _____ loss, mental and physical _____, skin _____, feeling _____, _____ cramps, _____, arthritis, _____ metabolic rate, and decreased _____

-Caused by _____ deficiency, chronic autoimmune _____, thyroid _____, and disease of the _____ or _____

-If untreated, may lead to ____, ____, or ____

-Sonographic appearance - _____, _____geneous irregular thyroid gland with possible _____

Hypothyroidism:

-Inadequate production of triiodothyronine (T3) and thyroxine (T4)

-Symptoms include weight gain, hair loss, mental and physical lethargy, skin dryness, feeling cold, muscle cramps, constipation, arthritis, slow metabolic rate, and decreased heart rate

-Caused by iodine deficiency, chronic autoimmune thyroiditis, thyroid hormone failure, and disease of the pituitary gland or hypothalamus

-If untreated, may lead to myxedema, coma, or death

-Sonographic appearance - enlarged, heterogeneous irregular thyroid gland with possible calcifications

What pathology does the following sonographic appearance describe?:

Normal or enlarged heterogeneous hypervascular thyroid gland

Hyperthyroidism

What pathology does the following sonographic appearance describe?:

Enlarged, heterogeneous irregular thyroid gland with possible calcifications

Hypothyroidism

Thyroid nodules:

___% are benign

___% are cysts

___% are malignant

60% are benign

20% are cysts

20% are malignant

Benign Thyroid Neoplasms - Adenoma:

Etiology

-Composed of _____ tissue

-____ common thyroid neoplasm

Clinical findings

-Asymptomatic

-_____

-_____ prevalence (7:1)

Sonographic findings

-Homogeneous _____ mass

-Prominent _____echoic peripheral halo

-_____ blood flow

-May degenerate and appear _____

-"_____" nodule on nuclear medicine scan

Etiology

-Composed of epithelial tissue

-Most common thyroid neoplasm

Clinical findings

-Asymptomatic

-Hyperthyroidism

-Female prevalence (7:1)

Sonographic findings

-Homogeneous echogenic mass

-Prominent hypoechoic peripheral halo

-Peripheral blood flow

-May degenerate and appear complex

-"Cold" nodule on nuclear medicine scan

What is the most common thyroid neoplasm?

Adenoma

Benign Thyroid Neoplasms - Cyst:

10-15% of solitary thyroid nodules

Etiology

-_____ cyst

Clinical findings

-Asymptomatic

-_____ neck mass

Sonographicfindings

-_____echoic mass

-_____ wall margins

-Posterior acoustic _____

-May demonstrate internal _____

Etiology

-Simple cyst

Clinical findings

-Asymptomatic

-Palpable neck mass

Sonographicfindings

-Anechoic mass

-Smooth wall margins

-Posterior acoustic enhancement

-May demonstrate internal debris

Benign Thyroid Neoplasms - Goiter:

Etiology

-_____ deficiency

-_____ deficiency

-_____ disease

-Thyroiditis

Clinical findings

-Palpable neck mass

-Dys____

-Dys____

-_____ or _____

Sonographic findings

-_____ thyroid lobe(s)

-Diffusely _____

-Areas of _____ degeneration

-May demonstrate _____

Etiology

-Thyroid hormone deficiency

-Iodine deficiency

-Graves' disease

-Thyroiditis

Clinical findings

-Palpable neck mass

-Dysphagia

-Dyspnea

-Hyperthyroidism or hypothyroidism

Sonographic findings

-Enlarged thyroid lobe(s)

-Diffusely heterogeneous

-Areas of cystic degeneration

-May demonstrate calcification(s)

Benign Thyroid Neoplasms - Hashimoto disease:

Etiology

-Chronic ____ ____ disease

Clinical findings

-Often _____

-_____thyroidism

-Leukocytosis

-Sore _____

-_____

Sonographic findings

-_____ _____echoic thyroid glands

-_____vascular parenchyma

Etiology

-Chronic lymphatic inflammatory disease

Clinical findings

-Often painless

-Hypothyroidism

-Leukocytosis

-Sore throat

-Fever

Sonographic findings

-Enlarged hypoechoic thyroid glands

-Hypervascular parenchyma

Benign Thyroid Neoplasms - Thyroiditis:

Etiology

-_____ disease

-_____ syndrome

-_____ infection

Clinical findings

-_____thyroidism followed by _____thyroidism

-_____

-Fever

-Leukocytosis

-_____ pain

-_____

Sonographic findings

-_____ ____echoic gland

-_____vascular perenchyma

-Discrete _____

Etiology

-Hashimoto disease

-De Quervain syndrome

-Viral infection

Clinical findings

-Hyperthyroidism followed by hypothyroidism

-Fatigue

-Fever

-Leukocytosis

-Neck pain

-Dysphagia

Sonographic findings

-Enlarged hypoechoic gland

-Hypervascular perenchyma

-Discrete nodules

Cysts of the Neck - Brachial cleft cyst:

Etiology

-Congenital _____ of the brachial cleft

Clinical findings

-Asymptomatic

-Palpable _____ neck mass

Sonographic findings

-Anechoic _____ neck mass

-Located directly below the angle of the _____

-Located _____ to the SCM muscle

-May demonstrate internal _____

Etiology

-Congenital diverticulum of the brachial cleft

Clinical findings

-Asymptomatic

-Palpable lateral neck mass

Sonographic findings

-Anechoic superficial neck mass

-Located directly below the angle of the mandible

-Located anterior to the SCM muscle

-May demonstrate internal debris

Cysts of the Neck - Cystic hygroma:

Etiology

-Inadequate drainage of lymph fluid into the _____

-Increased _____ from the epithelial lining

-Associated with _____ syndrome

Clinical findings

-Asymtpomatic

-_____ neck mass

Sonographic findings

-_____-walled, _____ cystic structure

Etiology

-Inadequate drainage of lymph fluid into the jugular vein

-Increased secretion from the epithelial lining

-Associated with Turners syndrome

Clinical findings

-Asymtpomatic

-Posterior neck mass

Sonographic findings

-Thin-walled, multilocular cystic structure

Cysts of the Neck - Thyroglossal cyst:

Etiology

-_____ remnant

Clinical findings

-Asymptomatic

-Palpable _____ _____ neck mass

Sonographic findings

-____echoic superficial neck mass

-Located between the _____ and the _____

-May demonstrate internal _____

-Document relationship to _____ (e.g., inferior)

Etiology

-Embryonic remnant

Clinical findings

-Asymptomatic

-Palpable superficial anterior neck mass

Sonographic findings

-Anechoic superficial neck mass

-Located between the tongue and the thyroid isthmus

-May demonstrate internal debris

-Document relationship to hyoid bone (e.g., inferior)

Malignant Thyroid Neoplasms - Carcinoma:

Etiology

-_____ (80%)

-_____ (5-15%)

-_____ (5%)

-_____ (2%)

Clinical findings

-Palpable _____ mass

-_____

-_____

-_____

-Neck pain

-Lymphadenopathy

Sonographic findings

-_____echoic mass

-_____ borders

-Thick _____ peripheral halo

-_____

-May degenerate

-Increase in _____ from previous exam

-_____ to cervical lymph nodes, lung, bone, and larynx

Etiology

-Papillary (80%)

-Follicular (5-15%)

-Medullary (5%)

-Anaplastic (2%)

Clinical findings

-Palpable neck mass

-Dysphagia

-Dyspnea

-Hoarseness

-Neck pain

-Lymphadenopathy

Sonographic findings

-Hypoechoic mass

-Irregular borders

-Thick incomplete peripheral halo

-Microcalcification(s)

-May degenerate

-Increase in size from previous exam

-Metastases to cervical lymph nodes, lung, bone, and larynx

Parathyroid Pathology - Hypercalcemia:

-Elevated _____ in the blood

-Symptoms include ____, ____, ____ pain, muscle pain and ____, ____ formation, ____, arthritis, weight ____, and bone ____

-Associated with ____parathyroidism, metastatic ____ tumor, ____ disease, and ____

-Extremely high levels may result in ____, ____, ____ failure, or ____

-Elevated calcium in the blood

-Symptoms include confusion, anorexia, abdominal pain, muscle pain and weakness, stone formation, gout, arthritis, weight loss, and bone demineralization

-Associated with hyperparathyroidism, metastatic bone tumor, Paget disease, and osteoporosis

-Extremely high levels may result in coma, shock, kidney failure, or death

Parathyroid Pathology - Hyperparathyroidism:

-Excessive function of the _____

-Most commonly caused by a _____ (80%)

-May lead to _____ and _____

-Elevated levels of ______

-Excessive function of the parathyroid glands

-Most commonly caused by a parathyroid adenoma (80%)

-May lead to osteoporosis and nephrolithiasis

-Elevated levels of parathormone

Parathyroid Pathology - Hypocalcemia:

-Deficiency of _____ in the blood

-Symptoms may include _____, _____ of the hands, feet, lips, and tongue; _____ cramps; _____; and fatigue

-Associated with _____, _____ failure, acute _____, and inadequate amount of _____ and _____

-Deficiency of calcium in the blood

-Symptoms may include cardiac arrhythmia, hyperparesthesia of the hands, feet, lips, and tongue; muscle cramps; anxiety; and fatigue

-Associated with hypoparathyroidism, kidney failure, acute pancreatitis, and inadequate amount of magnesium and protein

Parathyroid Pathology - Hypoparathyroidism:

-Insufficient function of the _____

-Associated with _____ and primary _____

-Insufficient function of the parathyroid glands

-Associated with hypocalcemia and primary parathyroid dysfunction

Parathyroid Pathology - Adenoma:

Etiology

-Exposure to _____

Clinical findings

-_____

-Decrease in serum _____

-Increase in _____

-Hypertension

-_____lithiasis

-_____lithiasis

-Pancreatitis

Sonographic findings

-_____echoic mass located _____ and _____ to the thyroid gland

-_____ in shape

-_____ vascular flow within larger lesions

Etiology

-Exposure to ionizing radiation

Clinical findings

-Hypercalcemia

-Decrease in serum phosphorus

-Increase in parathormone

-Hypertension

-Nephrolithiasis

-Cholelithiasis

-Pancreatitis

Sonographic findings

-Hypoechoic mass located posterior and medial to the thyroid gland

-Oval in shape

-Internal vascular flow within larger lesions

Parathyroid Pathology - Carcinoma:

Etiology

-_____ neoplasm

-_____-growing

-Tend to _____ surrounding tissues

Clinical findings

-_____

-Elevated _____ level

-_____ palpable neck mass

Sonographic findings

-_____echoic _____ mass

-Round or oval in shape

-_____ of sound (dense)

-_____vascular

Etiology

-Epithelial neoplasm

-Slow-growing

-Tend to infiltrate surrounding tissues

Clinical findings

-Hypercalcemia

-Elevated parathormone level

-Firm palpable neck mass

Sonographic findings

-Hypoechoic lobulated mass

-Round or oval in shape

-Attenuation of sound (dense)

-Hypervascular

Parathyroid Pathology - Cyst:

Etiology

-Uncommon

Clinical findings

-Asymptomatic

-_____ prevalence

-_____ yrs of age

Sonographic findings

-_____echoic mass located _____ and ______ to the thyroid gland

-_____ wall margins

-Posterior acoustic _____

Etiology

-Uncommon

Clinical findings

-Asymptomatic

-Female prevalence

-60-70 yrs of age

Sonographic findings

-Anechoic mass located posterior and medial to the thyroid gland

-Smooth wall margins

-Posterior acoustic enhancement

What is the most common vascular mass in infants?

Hemangioma

Salivary Gland Pathology - Hemangioma:

Etiology

-Most common _____ mass in infants

-Usually located in the _____ gland (80%)

Clinical findings

-Painless

-_____, _____ growing mass

-May have _____ or _____ skin colouring

Sonographic findings

-_____geneous, _____echoic enlargement or mass

-_____vascular

-_____ circumscribed

-Usually located in the _____ gland (80%)

Etiology

-Most common vascular mass in infants

-Usually located in the parotid gland (80%)

Clinical findings

-Painless

-Compressible, slow growing mass

-May have red or blue skin colouring

Sonographic findings

-Heterogeneous, hypoechoic enlargement or mass

-Hypervascular

-Well circumscribed

-Usually located in the parotid gland (80%)

Salivary Gland Pathology - Parotitis:

Etiology

-Chronic _____ (salivary gland infection)

-Present _____ yrs of age

-More common in _____

Clinical findings

-Pain and swelling especially _____

Sonographic findings

-_____ _____geneous gland(s)

-Excretory duct(s) may be _____

-______ (presence of calculi in the salivary glands or ducts)

-_____ vascular flow

Etiology

-Chronic sialadenitis (salivary gland infection)

-Present 3-6 yrs of age

-More common in males

Clinical findings

-Pain and swelling especially postprandial

Sonographic findings

-Enlarged heterogeneous gland(s)

-Excretory duct(s) may be dilated

-Sialolithiasis (presence of calculi in the salivary glands or ducts)

-Normal vascular flow

Salivary Gland Pathology - Sialadenitis:

Etiology

-Acute ____ or ____ infection

Clinical findings

-Painful swelling ___laterally

-Swelling during _____

-_____ pain

-_____ of skin

Sonographic findings

-_____, diffusely ____echoic gland

-_____ appearance

-_____vascular

-Cervical _____

Etiology

-Acute viral or bacterial infection

Clinical findings

-Painful swelling bilaterally

-Swelling during eating

-Postprandial pain

-Reddening of skin

Sonographic findings

-Enlarged, diffusely hypoechoic gland

-Complex appearance

-Hypervascular

-Cervical lymphadenopathy

Salivary Gland Pathology - Sialolithiasis:

-_____ in 60-90% of cases

-_____ in 10-20% of cases

Etiology

-_____ in 50% of cases

Clinical findings

-Pain and swelling during _____

-_____ mass

Sonographic findings

-_____ or _____ echogenic focus(i)

-Posterior acoustic _____

-Submandibular in 60-90% of cases

-Parotid in 10-20% of cases

Etiology

-Infection in 50% of cases

Clinical findings

-Pain and swelling during eating

-Palpable mass

Sonographic findings

-Intraductal or intraglandular echogenic focus(i)

-Posterior acoustic shadowing

Salivary Gland Pathology - Sialosis:

Etiology

Associated with:

-_____ diseases

-Hepatic _____

-Chronic _____

-Malnutrition

Clinical findings

-_____, painless gland _____

Sonographic findings

-_____, _____echoic gland with increased attenuation

-_____ increase in vascularity

Etiology

Associated with:

-Endocrine diseases

-Hepatic cirrhosis

-Chronic alcoholism

-Malnutrition

Clinical findings

-Recurrent, painless gland swelling

Sonographic findings

-Enlarged, hyperechoic gland with increased attenuation

-No increase in vascularity

Salivary Gland Pathology - Sjogren's Syndrome:

Etiology

-Chronic _____ disease

Clinical findings

-Eye and mouth _____

-Severe _____

-_____ saliva

Sonographic findings

-_____geneous gland with small, oval _____echoic or _____echoic areas

-May demonstrate _____

Etiology

-Chronic autoimmune disease

Clinical findings

-Eye and mouth dryness

-Severe dental caries

-Frothy saliva

Sonographic findings

-Inhomogeneous gland with small, oval hypoechoic or anechoic areas

-May demonstrate hypervascularity