Neck and Thyroid

Chapter 10. Neck and Thyroid

Patient Preparation

• No preparation is required for neck and thyroid imaging.

Equipment and Technical Factors

• A high-frequency linear array is used for imaging the neck and thyroid.
• To image large superficial structure pathology, a curved linear or sector transducer with a stand-off pad to place the anatomy into the wider portion of the image may be used.

Imaging Protocol

• Longitudinal and transverse axes images of the organ or area of interest with the neck slightly extended (hyperextension is contraindicated).
• Demonstrate relational anatomy.

Variants

• Pyramidal lobe of the thyroid

Sonographic Measurements

Thyroid

• Length: 4.0−6.0 cm
• Width: 1.3−1.8 cm
• Depth (AP): 1.3−1.8 cm
• Isthmus: 3.0 mm

Neck

• Length, depth, and width of cyst, mass, or diseased area.
Neck and Thyroid
Sonographic Finding(s) Clinical Presentation Differential Diagnosis Next Step
Solid mass(es) more echogenic than thyroid with hypoechoic halo
Well defined
Possible cystic degeneration or “eggshell” calcification noted
Predominately cystic mass(es)
May appear complex
Asymptomatic
Possible palpable nodule in thyroid
Thyroid adenoma
Degenerating adenoma
Adenomas may undergo cystic degeneration and appear as complex mass
Do not overlook the isthmus
Use light transducer pressure to avoid missing small lesions
Cystic structure with irregular walls and internal echoes
Asymptomatic
Possible palpable thyroid nodule
Thyroid cyst (with/without hemorrhage)
Degenerating adenoma
Do not overlook the isthmus
Use light transducer pressure to avoid missing small lesions
Solitary hypoechoic mass with irregular border and microcalcifications
Enlarged lymph node(s) in neck may be noted; the node(s) may be predominately cystic
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