CHAPTER 38 CHEST,THYROID,
PARATHYROID
Denver Sapo
CHEST
Pleural fluid
Exudateechogenic, contains
floating particles or layering
debris, or is septated
Transudate, exudateanechoic
Pleural thickening
uniform, undulating, or plaque-
like thickening of the pleura
Pleural Masses
nodular pleural thickening or
hypoechoic soft-tissue masses
in the pleural space projecting
from the
pleural surface
Pneumothorax
highly echogenic reflective line
lack the "gliding sign
Consolidation
filling of the air spaces of the
lung with fluid and inflammatory
cells
solid and hypoechoic with
echogenicity similar to that of
the liver
Sonographic air bronchograms
and sonographic air
alveolograms
Sonographic fluid bronchograms
Atelectasis
Collapse of the air spaces with
absorption of air
wedge shaped
Pulmonary sequestration
does not communicate with the
bronchial tree
Most occur at the lung base
Intralobar sequestrations are
within the visceral pleura
Extralobar sequestrations are
invested by their own separate
pleura
feeding artery arising from the
aorta
Extralobar sequestrations drain
via a systemic vein
intralobar sequestrations
connect to the pulmonary veins
THYROID
Anatomy
size (5 x 2 x 2 cm)
homogeneous with fine medium
level echogenicity greater than
that of the muscle
Thyroid Nodules
US is highly sensitive for the
detection of thyroid nodules;
however, its specificity for
determining malignancy is low.
Benign Thyroid Nodules
Adenomatous nodules
o colloid nodules
o most common thyroid
nodule
o isoechoic or hypoechoic
to thyroid parenchyma
and commonly show
degenerative changes
with prominent cystic
components, necrosis,
hemorrhage, and
calcification
Follicular adenoma
o most common benign
neoplasm
o Autonomous
hyperfunctioning
adenomas are a cause of
hyperthyroidism
o most adenomas cause no
alteration of overall
thyroid function
o most are solitary, solid,
and well encapsulated
o may be hypoechoic,
hyperechoic, or isoechoic
to thyroid parenchyma
o Hyperfunctioning
adenomas are commonly
strikingly hypervascular
on color flow US
Thyroid cystsextremely rare,
epithelial-lined, simple cysts
Malignant Thyroid Nodules
 Papillary thyroid carcinoma
o 75% to 80% of thyroid
cancer
o most patients are female
o Nodules are hypoechoic
and commonly multiple.
o Punctate internal
calcifications
representingbpsammoma
bodies, are common
(42%) and highly
indicative of malignancy
Follicular thyroid carcinoma
(10% to 20%)
o invasion of blood vessels
is characteristic
o common hematogenous
spread to lung and bone
o Features that favor
carcinoma over adenoma
larger size
lack of an
echolucent halo
hypoechoic
appearance
absence of cystic
change
Medullary thyroid carcinoma
(3% to 5%)
o arises from parafollicular
C cells that secrete
calcitonin, which serves
as a tumor marke
o associated with MEN II
o US appearance is similar
to papillary carcinoma
Anaplastic thyroid
can:inoma (1% to 2%)
o lethalmalignancy of the
elderly.
o ill defined,
heterogeneous,
hypoechoic, solid mass.
PARATHYROID
radionuclide imaging is the
most sensitive and accurate
measure only S x 3 x 1 mm in
size
not usually demonstrated by
any imaging method
most enlarged glands are
found beneath the thyroid
lobes between the trachea and
carotid sheath.
Ectopic glands may be found
between the upper pole of the
thyroid and the thymus
Hyperparathyroidism
Affects women two to three
times more often than men
A single benign
hyperfunctioning
Most cases of hyperplasia
involve all glands
unexplained hypercalcemia and
is confirmed by elevated serum
parathyroid hormone level
Secondary
hyperparathyroidism occurs
as a result of chronic
hypocalcemia in patients with
chronic renal failure.
When the chronically
overstimulated glands become
autonomous, the term tertiary
hyperparathyroidism is used.
Parathyroid adenomas
hypoechoic, solid, oval, and well-
defined masses
Color Doppler demonstrates
hypervascularity
CT is best performed with IV contrast
to demonstrate the contrast-enhancing
parathyroid nodules
Parathyroid hyperplasia
Affects all the parathyroid glands
same imaging characteristics as
parathyroid adenomas
Parathyroid carcinoma
distinguished by larger size (>2cm)
than parathyroid adenomas
usually more heterogeneous with
cystic degeneration and occasional
calcification
Color flow US is useful to demonstrate
the invasion of adjacent vessels or
muscle
Ectopic parathyroids
best localized by radionuclide imaging
 CT or MR. is usually needed to show
the anatomic relationships when they
are located in the mediastinum