10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College of Surgeons San Francisco, October 21, 2010 Lisa A. Orloff, MD, FACS Normal Head & Neck Ultrasound Anatomy Head & Neck Anatomy • Thyroid • Trachea • Esophagus
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Head and Neck UltrasoundImage Interpretation
Post Graduate Thyroid and Parathyroid Ultrasound Course
American College of Surgeons San Francisco, October 21, 2010
Lisa A. Orloff, MD, FACS
Normal Head & NeckUltrasound Anatomy
Head & Neck Anatomy
• Thyroid
• Trachea
• Esophagus
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Normal phonation Normal Swallow
Ultrasound Interpretation
Thyroid
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Normal Thyroid Benign Thyroid Nodules
Comet tail echoesCystic degeneration
Colloid Nodules
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Colloid Nodules
Comet tail echoes
“spongiform”
Benign Thyroid Nodule (BTN)
Coarse calcification
thyroid hemorrhagic nodule
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Benign Thyroid Nodule
Homogeneous, peripheral blood flow, well-defined
Ultrasound CharacteristicsBenign v. Malignant Thyroid Nodules
Benign
• Isoechoic/hyperechoic
• (Coarse calcifications)
• Thin, well-defined halo
• Regular margin
• Hypovascular
• No lymphadenopathy
Malignant
•Hypoechoic
•Microcalcifications
•Thick or absent halo
•Irregular margin
•Increased vascularity
•Lymphadenopathy
Papillary Carcinoma
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Cystic Papillary Carcinoma Nonpalpable PTC primary tumor
Metastatic Papillary CA
Follicular Adenoma Follicular Carcinoma
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Medullary Thyroid Cancer Anaplastic Thyroid Cancer
Left trans thyroidLeft trans level II
Thyroglossal Duct Cyst
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Ultrasound Interpretation
Parathyroid
Tc 99m Sestamibi
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Why Parathyroid Ultrasound?
• localize SITE as well as SIDE• 3D view and relation to other structures• suspect intrathyroidal adenoma• unexpected thyroid pathology which can be
addressed at time of parathyroid exploration• US-guided FNA and PTH assay• US and Sestamibi are complementary (thyroid
nodules, mediastinal/retroesophageal parathyroids)
Parathyroid adenoma
Right transverse
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Ultrasound Interpretation
Lymph Nodes
Ultrasound CharacteristicsBenign v. Malignant Lymph Nodes
Benign• Oval• Small• Hilum visible• Isoechoic/hyperechoic• No calcifications• Regular margin• Hilar vascular pattern• Single• Distinct from surrounds
Malignant• Round• Large• Hilum not visible• Hypoechoic/heterogeneous• Microcalcifications• Irregular margin• Disordered vascular pattern• Multiple• Invasion of surrounds
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Hilar blood flow (video)
Benign lymph node
Malignant Lymphoma
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Rule out carotid invasion Regional Designation of Node Distribution
Ultrasound
Parotid/Salivary gland
pleomorphic adenoma of parotid
left parotidtransventral
mandiblemandible
mastoidmastoid
parotidparotid
massmass
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Transverse
Sagittal
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Alcohol sclerotherapy of Parotid Lymphoepithelial Cyst
Tubular structure
Doppler
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Sjogrens syndrome
Ultrasound
Esophagus
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General
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T2W
Lymphangioma
tongue basetransverseright
massmass
FOMFOM
THITHI
tongue base carcinoma
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Supraglottic carcinoma
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Branchial Cleft Cyst Branchial Cleft Cyst
Abscessed Lymph Node Paraganglioma
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Thrombosed Internal Jugular Vein
Ultrasound-guided Procedures
Fine Needle Aspiration
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Recurrent Metastatic SCCA - USGFNA
Needle Entry at Mid-point of Transducer and 3-4 mm from Edge FNA: short axis technique
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Angle of Needle-to-transducer Depends on Depth of Target Lesion
superficial
intermediate
deep
Intraoperative Ultrasound
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