head & neck anatomy - ucsf medical education · 10/22/2010 1 head and neck ultrasound image...

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10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College of Surgeons San Francisco, October 21, 2010 Lisa A. Orloff, MD, FACS Normal Head & Neck Ultrasound Anatomy Head & Neck Anatomy • Thyroid • Trachea • Esophagus

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Page 1: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Head and Neck UltrasoundImage Interpretation

Post Graduate Thyroid and Parathyroid Ultrasound Course

American College of Surgeons San Francisco, October 21, 2010

Lisa A. Orloff, MD, FACS

Normal Head & NeckUltrasound Anatomy

Head & Neck Anatomy

• Thyroid

• Trachea

• Esophagus

Page 2: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Page 3: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Normal phonation Normal Swallow

Ultrasound Interpretation

Thyroid

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10/22/2010

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Normal Thyroid Benign Thyroid Nodules

Comet tail echoesCystic degeneration

Colloid Nodules

Page 5: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Colloid Nodules

Comet tail echoes

“spongiform”

Benign Thyroid Nodule (BTN)

Coarse calcification

thyroid hemorrhagic nodule

Page 6: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Benign Thyroid Nodule

Homogeneous, peripheral blood flow, well-defined

Ultrasound CharacteristicsBenign v. Malignant Thyroid Nodules

Benign

• Isoechoic/hyperechoic

• (Coarse calcifications)

• Thin, well-defined halo

• Regular margin

• Hypovascular

• No lymphadenopathy

Malignant

•Hypoechoic

•Microcalcifications

•Thick or absent halo

•Irregular margin

•Increased vascularity

•Lymphadenopathy

Papillary Carcinoma

Page 7: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Cystic Papillary Carcinoma Nonpalpable PTC primary tumor

Metastatic Papillary CA

Follicular Adenoma Follicular Carcinoma

Page 8: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Medullary Thyroid Cancer Anaplastic Thyroid Cancer

Left trans thyroidLeft trans level II

Thyroglossal Duct Cyst

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10/22/2010

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Ultrasound Interpretation

Parathyroid

Tc 99m Sestamibi

Page 10: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Why Parathyroid Ultrasound?

• localize SITE as well as SIDE• 3D view and relation to other structures• suspect intrathyroidal adenoma• unexpected thyroid pathology which can be

addressed at time of parathyroid exploration• US-guided FNA and PTH assay• US and Sestamibi are complementary (thyroid

nodules, mediastinal/retroesophageal parathyroids)

Parathyroid adenoma

Right transverse

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Page 12: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Ultrasound Interpretation

Lymph Nodes

Ultrasound CharacteristicsBenign v. Malignant Lymph Nodes

Benign• Oval• Small• Hilum visible• Isoechoic/hyperechoic• No calcifications• Regular margin• Hilar vascular pattern• Single• Distinct from surrounds

Malignant• Round• Large• Hilum not visible• Hypoechoic/heterogeneous• Microcalcifications• Irregular margin• Disordered vascular pattern• Multiple• Invasion of surrounds

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10/22/2010

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Page 18: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Hilar blood flow (video)

Benign lymph node

Malignant Lymphoma

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10/22/2010

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10/22/2010

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Page 21: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Rule out carotid invasion Regional Designation of Node Distribution

Ultrasound

Parotid/Salivary gland

pleomorphic adenoma of parotid

left parotidtransventral

mandiblemandible

mastoidmastoid

parotidparotid

massmass

Page 22: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

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Transverse

Sagittal

Page 23: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Alcohol sclerotherapy of Parotid Lymphoepithelial Cyst

Tubular structure

Doppler

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10/22/2010

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Sjogrens syndrome

Ultrasound

Esophagus

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10/22/2010

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10/22/2010

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General

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10/22/2010

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T2W

Lymphangioma

tongue basetransverseright

massmass

FOMFOM

THITHI

tongue base carcinoma

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10/22/2010

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Supraglottic carcinoma

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Page 30: Head & Neck Anatomy - UCSF Medical Education · 10/22/2010 1 Head and Neck Ultrasound Image Interpretation Post Graduate Thyroid and Parathyroid Ultrasound Course American College

10/22/2010

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Branchial Cleft Cyst Branchial Cleft Cyst

Abscessed Lymph Node Paraganglioma

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10/22/2010

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Thrombosed Internal Jugular Vein

Ultrasound-guided Procedures

Fine Needle Aspiration

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10/22/2010

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Recurrent Metastatic SCCA - USGFNA

Needle Entry at Mid-point of Transducer and 3-4 mm from Edge FNA: short axis technique

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10/22/2010

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Angle of Needle-to-transducer Depends on Depth of Target Lesion

superficial

intermediate

deep

Intraoperative Ultrasound

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