ABSTRACT
Ultrasound examination of the thyroid gland permits to evaluate its size, echogenicity, margins, and stroma. An abnormal ultrasound image of the thyroid, accompanied by other diagnostic investigations, facilitates therapeutic decision-making. The ultrasound image of a normal thyroid gland does not change substantially with patient's age. Nevertheless, erroneous impressions in thyroid imaging reports are sometimes encountered. These are due to diagnostic pitfalls which cannot be prevented by either the continuing development of the imaging equipment, or the growing experience and skill of the practitioners. Our article discusses the most common mistakes encountered in US diagnostics of the thyroid, the elimination of which should improve the quality of both the ultrasound examination itself and its interpretation. We have outlined errors resulting from a faulty examination technique, the similarity of the neighboring anatomical structures, and anomalies present in the proximity of the thyroid gland. We have also pointed out the reasons for inaccurate assessment of a thyroid lesion image, such as having no access to clinical data or not taking them into account, as well as faulty qualification for a fine needle aspiration biopsy. We have presented guidelines aimed at limiting the number of misdiagnoses in thyroid diseases, and provided sonograms exemplifying diagnostic mistakes.
ABSTRACT
Ultrasonography is a primary imaging technique in patients with suspected thyroid disease. It allows to assess the location, size and echostructures of the thyroid gland as well as detect focal lesions, along with indication of their size, echogenicity, echostructure and vascularity. Based on these features, ultrasound examination allows to predict abnormal focal lesions for biopsy and monitor the biopsy needle track. This paper presents the standards of thyroid ultrasound examination regarding ultrasound apparatus technical requirements, scanning techniques, readings, measurements, and the description of the examination. It discusses the ultrasound features of increased malignancy risk in focal lesions (nodules) found in the thyroid gland. It presents indications for fine needle aspiration biopsy of the thyroid gland for the visibility of single nodules (focal lesions) and numerous lesions as well as discusses contraindications for thyroid biopsy. It describes the biopsy technique, possible complications and rules for post-biopsy monitoring of benign lesions. The paper is an update of the Standards of the Polish Ultrasound Society issued in 2011. It has been prepared on the basis of current literature, taking into account the information contained in the following publications: Thyroid ultrasound examination and Recommendations of the Polish Ultrasound Society for the performance of the FNAB of the thyroid.
ABSTRACT
Adrenal tuberculosis is relatively infrequent cause of primary adrenocortical insufficiency in developed countries. Adrenal involvement is most often the result of hematogenous spread of the pulmonary tuberculosis. Isolated adrenal tuberculosis, especially with enlargement of adrenal glands can cause diagnostic problems and requires differentiation from primary or secondary neoplastic disease. In this paper we present a case of 61-year-old man with several months history of adrenocortical insufficiency without signs of pulmonary tuberculosis. Computed tomography scan revealed asymmetrical mass-like enlargement in adrenal glands. Despite of consecutive investigations, the diagnosis remained uncertain. Because of the possibility of neoplastic process of unknown origin, the patient was qualified for surgical exploration during which both enlarged glands were removed. The diagnosis of tuberculosis was made on microscopic examination.
Subject(s)
Addison Disease/microbiology , Addison Disease/surgery , Tuberculosis, Endocrine/complications , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Graves' orbitopathy is caused by intraorbital inflammatory reaction due to autoimmune thyroid disease. In most cases the diagnosis is based on the coexistence of typical eye signs and hyperthyroidism symptoms. In presented case, the absence of thyroid dysfunction implicated performance of differential diagnosis. Among many available diagnostic tools nuclear magnetic resonance seems to be the most accurate in confirmation of diagnosis of Graves' orbitopathy.
Subject(s)
Graves Disease/diagnosis , Orbit/pathology , Aged , Female , Graves Disease/complications , Graves Disease/diagnostic imaging , Humans , Magnetic Resonance Imaging , RadiographyABSTRACT
Impairment of swallowing is a common symptom in advanced stage of Parkinson's disease and severe defect of this function may cause aspiration pneumonia, problems with food intake and cachexy. The aim of this study was to assess the reflex and oral, pharyngeal, oesophageal phase of swallowing. Eleven patients with Parkinson's disease and 9 healthy subjects were investigated by electromyography (EMG) and oesophageal scintigraphy. The study demonstrates delayed triggering of swallowing reflex (543 +/- 84 ms in patients with PD vs. 230 +/- 66 ms in controls, p < 0.05) and prolongation of laryngeal movement (1880 +/- 140 ms vs. 1349 +/- 154 ms, p < 0.05). The prolongation of the oesophageal phase of swallowing with predilection to retention of water in lower one/third part of esophagus (12.45 +/- 2.45 s vs. 6.45 +/- 1.18 s, p < 0.001) was observed. The dysphagia limit, that is the maximum amount of water swallowed at once, was also evaluated (all normal subjects are able to swallow 20 ml water or more at once). In the studied patients with Parkinson's disease it was 4.5 +/- 0.86 ml. These results evidently and objectively indicate the presence of swallowing disorders in Parkinson's disease. Dysphagia was observed in all studied patients, although only 8 of them complained about it. In other 3 cases the impairment of swallowing was subclinical and it was connected with prolongation of oesophageal phase.
