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Thyroid imaging with high-field-strength surface-coil MR.

Magnetic resonance (MR) imaging of the thyroid was performed with a 1.5-T system and local receiver coil in 19 "healthy" subjects and 34 patients with various focal and diffuse thyroid disorders. The normal gland was typically homogeneous with increased intensity relative to that of muscle on images obtained with long repetition times (TRs) and long echo times (TEs). Adjacent structures in the neck and upper mediastinum were well displayed. Thyroid nodules as small as 4-5 mm were identified. Follicular adenomas appeared as well-circumscribed nodules of heterogeneous intensity, increasing significantly in signal with long TRs/TEs. Colloid cysts and hemorrhagic cysts had homogeneous high signal with both short and long TRs/TEs. Two of three carcinomas were seen as poorly marginated lesions with associated cervical lymphadenopathy clearly depicted as increased intensity with long TRs/TEs. A follicular adenoma containing microscopic papillary carcinoma appeared similar to other benign adenomatoid nodules. A functioning nodule was isointense with normal gland at all pulse sequences. Characteristic patterns of diffuse abnormality were observed in cases of multinodular goiter, Hashimoto thyroiditis, and Graves disease, although additional cases are required to determine specificity. High-field-strength surface-coil MR imaging appears to be a sensitive method for identifying gross morphology of focal, multinodular, and diffuse disorders of the thyroid and involvement of surrounding structures in the neck.

Adult↗

Thyroid tumor imaging.

Clinical assessment of a patient with a focal or diffuse thyroid tumor is but the first step in diagnostic evaluation. The diagnostic imaging process augments information obtained by the inspecting eye and the palpating hand; it allows the qualification (for example, cystic v solid) and the quantification (for example, size, extension, and assessment of physiologic function) of the thyroid tumor mass. This diagnostic input allows the establishment of a more realistic provisional diagnosis and directs a rational treatment approach to the patient. This presentation reviews the major imaging modalities available for thyroid tumor evaluation: diagnostic ultrasound, radionuclide scans, and conventional radiology and computed tomography. The applications of these various modalities and their critical potentials and limitations are placed in a contemporary clinical setting. It is hoped that an increasing familiarity with these imaging modalities will give better direction to the specialist in otolaryngology--head and neck surgery and greater surgical benefit to his or her patients.

Adenocarcinoma↗

Heterotopic lingual brain in the newborn.

Heterotopic brain is a rare entity. Histologically, this lesion resembles mature brain and often contains specialized tissues similar to choroid plexus or glia. Specialized neural stains are necessary to differentiate this rare anomaly from other tumors or conditions found in the head and neck. The differential diagnosis includes squamous cell carcinoma, granular cell tumor, hemangioma, lymphangioma, thyroglossal duct cyst, dermoid cyst, hamartoma, rhabdomyosarcoma, and teratoma. We describe a newborn with heterotopic brain tissue occurring on the dorsum of the tongue. We found only one other description of this developmental aberration in the English literature. Our patient was successfully treated with carbon dioxide laser excision of the mass. There has been no evidence of complication or recurrence after one year of follow-up.

Brain↗

Threatened carotid artery rupture: a complication of radical neck surgery.

Carotid artery rupture is an infrequent but highly dangerous postoperative complication of radical head and neck surgery. The principal predisposing factors are radiation therapy, infection, tissue necrosis, vessel exposure, and pharyngeal fistula formation. Actual or threatened carotid artery rupture has been most commonly managed by ligation of the involved vessel. We present a patient who showed signs of impending carotid artery rupture after both irradiation and radical neck surgery. Balloon embolization was employed in preference to traditional carotid artery ligation. The patient's risk factors for carotid artery rupture are analyzed and the application of balloon embolization is discussed.

Carotid Arteries↗

Offspring of women infected with varicella during pregnancy: a prospective study.

Despite the well-recognized association between maternal varicella infection and a specific pattern of malformation in the offspring referred to as fetal varicella syndrome, the full spectrum of this disorder as well as its frequency in the offspring of women infected with varicella during pregnancy is unknown. In order to resolve these issues, we have evaluated pregnancy outcome in 194 women who contacted us during pregnancy, soon after the onset of their infection: 132 (68%) during the 1st trimester and 171 (88%) prior to the onset of the 20th week, the most critical period relative to fetal susceptibility. Of those 171 women, there were 146 liveborn babies, 6 spontaneous abortions, 7 therapeutic abortions (one because of an anencephalic fetus), 2 stillborn infants, and nine pregnancies lost to follow-up. Of the 146 liveborn births, there were 2 with features consistent with the fetal varicella syndrome: one a child with mild cutaneous scars on her face, arms, and legs, Horner syndrome involving her left eye and a scar on her retina, leading to blindness in that eye; and the other, a child with horizontal nystagmus who is otherwise normal at 1 year of age. An additional four liveborn infants had a single major malformation which included unilateral microtia, bowel obstruction secondary to an ileal band, bilateral double ureters, and a thyroglossal duct cyst. This study suggests that prenatal varicella infection is associated with a wider spectrum of severity than has been previously appreciated and indicates that maternal varicella infection prior to the 20th week of pregnancy is associated with only a small risk for the developing fetus.

Adult↗

Visualisation of a thyroglossal duct.

After ablation of an autonomously functioning thyroid nodule resulting from an adenoma, a previously suppressed scintigraphic image of a thyroglossal duct was visualised.

Adenoma↗

Thyroid imaging in a typical case of acute suppurative thyroiditis with abscess formation due to infection from a persistent thyroglossal duct.

The clinical evaluation of thyroid imaging with 99mTc, 201Tl, and 67Ga in the uncommon, but potentially serious, disorder of acute suppurative thyroiditis (AST) with abscess formation due to infection from a persistent thyroglossal duct is reported. The 99mTc image showed functioning areas of the diseased thyroid gland and the 201Tl image demonstrated abscess formation in the thyroid gland of this patient. In addition, marked 67Ga accumulation was demonstrated in a wide area covering not only the area of the thyroid gland involved, but also associated circumferential inflammatory lesions in a patient with AST. The net thyroid uptake of 67Ga at 72 hours was calculated to be 13.8% of the injected dose.

Abscess↗