Clinical Significance of Preoperative Studies in Diagnosis of Thyroid Nodule : FNAC, Ultrasonography, Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is critical to distinguish benign from malignant thyroid nodule and to select a patient for surgery. Fine needle aspiration cytology(FNAC) and various radiologic techniques are used in the evaluation of thyroid nodule. The purpose of this study is to evaluate the diagnostic accuracy of preoperative FNAC, ultrasonography(US) and computed tomography(CT) in thyroid nodule, and to identify the reliable factors of radiologic imaging in the differential diagnosis of thyroid nodule. MATERIALS AND METHOD: Retrospectively, we reviewed 34 patients among 50 patients with thyroid nodule who were evaluated by FNAC, US and CT and operated on at our Department from June 1995 to December 1998. By comparing the preoperative FNAC results, US and CT findings with postoperative pathologic diagnosis, the results were as followed. RESULTS: Overall diagnostic accuracy of FNAC, US, and CT was 84.4%, 88.2%, 79.4%. Solid nature, ill defined margin, calcification, lymphadenopathy on US imaging indicated the possibility of malignancy. Solid nature, ill defined margin, lymphadenopathy on CT imaging indicated the possibility of malignancy. CONCLUSION: This study suggests that FNAC has a high sensitivity(75.0%) and specificity(93.8%) rate and it is therefore a valuable initial diagnostic procedure. US has higher diagnostic accuracy than computued tomography.

Case Report: Intramasseteric Vascular Anomaly-Misdiagnosed to Parotid Sialolithiasis / 대한이비인후과학회지

Intramuscular hemangiomas are benign vascular lesions of skeletal muscle and constitutes less than 1% of all hemangiomas. Of all intramuscular hemangiomas, 13-25% occur in the head and neck, presenting lesions of enlarging soft tissue mass associated with pain. Usually they do not exhibit cutaneous changes, such as bluish skin discoloration as seen in cutaneous and superficial subcutaneous lesions. Because of their infrequency, deep location and unfamiliar presentation, intramuscular hemangomas are seldom correctly diagnosed clinically. We encountered a case of intramasseteric hemangioma in a 14-year-old female. She presented intermittent painful swelling on the right preauricular area. Sialography showed a multiple calcified lesion of the soft tissue, while CT scan and MRI showed a tumor mass lying in the masseter muscle. Angiography showed blush lesion but no tumor feeding arteries. After 6 months of intra-lesional sclerosing therapy with alcohol, total regression of tumor was obtained. As we experienced in this case, percutaneous sclerotherapy with alcohol could be the first therapeutic alternative.

Hypocalcemia Followed by Total Thyroidectomy with Central Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many controversies about the extent of thyroidectomy and neck dissection in cases of thyroid cancer. Hypocalcemia is one of serious complications after total thyroidectomy. The on-set of hypocalcemia depends on many factors and different literature cites variable incidence. This study was performed to evaluate the incidence of postoperative hypocalcemia and the safety of total thyroidectomy with central neck dissection in thyroid cancer. MATERIALS AND METHODS: We conducted a retrospective chart review of 17 patients who underwent total thyroidectomy for thyroid malignancies from June 1995 to December 1998. Routine central neck dissection was performed and modified radical neck dissection was done in cases with positive neck node. We analyzed the onset-time of hypocalcemia, serum albumin level, hypocalcemic incidence according to the number of identified and autotransplanted parathyroid glands, lowest calcium level, clinical features and duration of calcium replacement in hypocalcemic patients. RESULTS: The incidence of postoperative hypocalcemia was 76.5% (13/17)and most cases (58.9%)occurred on the first postoperative day. The serum albumin level was lower on the first postoperative day than on the third postoperative day. The average number of identified parathyroid glands was three, and the more parathyroid glands there are, the less hypocalcemia we found. Parathyroid gland autotransplantation were performed in 12 cases. Symptomatic transient hypocalcemia occurred in 6 cases (35.2%). Asymptomatic transient hypocalcemia occurred in 6 cases (35.2%). Permanent hypocalcemia occurred in 1 case (5.9%). CONCLUSION: The incidence of postoperative hypocalcemia was relatively high but half of them were asymptomatic. There are no need for thyroid hormone replacement in asymptomatic transient hypocalcemic patients and that we found total thyroidectomy with central neck dissection is a safe procedure in most of thyroid malignancies.