We studied the role of ultrasound assessment of the thyroid gland in detecting amyloid deposition in 9 patients confirmed to have renal amyloidosis because the thyroid gland is a readily accessible organ. Ultrasound examination of the thyroid gland showed a distinctive abnormal appearance in 7 patients. There was enlargement of one or both lobes of the thyroid, a high echogenicity approaching that of the surrounding connective tissue, and a very fine homogeneous echotexture similar to ground glass appearance. Four patients showed dilated follicles in the thyroid gland. The other two patients had normal ultrasound findings. Open wedge biopsy of the thyroid gland in 4 patients, (3 with abnormal ultrasound findings and 1 with normal ultrasound findings) showed amyloid deposits in the 3 patients with abnormal echo findings and no amyloid deposits in the 1 patient with normal findings. In 10 healthy individuals, 10 patients who were just initiated on maintenance hemodialysis and another 10 patients on dialysis for more than 1 year, the thyroid gland was of normal size and appearance in the ultrasound examination. We conclude that ultrasound examination by an experienced radiologist is a useful tool in the diagnosis of thyroid amyloidosis.

Objective: High resolution ultrasonography (US) has played a significant role in the study of salivary gland (SG) pathology and has surpassed sialography in the study of SG tumours. This report discusses the sonographic features of SG tumours examined during the last 5 years. The value of these features as diagnostic indicators of the nature (benign or malignant) and histotype of these tumours is assessed. Methods: High resolution ultrasonography was used in the study of 83 cases of salivary tumours, 78 of which were of the parotid gland and 5 of the submandibular gland. Sixty-six (80%) of these tumours were benign. An US scanner with a 7.5-MHz real-time linear probe was used. The diseased SG was examined in multiple planes to fully delineate and locate the lesions and to characterize their sonographic features. Results: US detected and correctly located all tumours. The sonographic features of the various tumour categories studied are presented with special emphasis on diagnostically significant ones. The value of these features as diagnostic indicators of the nature (benign or malignant) and the histotype of these tumours is assessed. In this study, the rate of correct US identification of tumour benignity was 100% in a group of 15 adenolymphomas and 12 benign non-epithelial tumours, and 94% in a group of 34 pleomorphic adenomas. Five cases of recurrent pleomorphic adenoma were also studied. Correct US identification of malignancy was achieved in 82% of malignant tumours (15 carcinomas and 2 isolated primary non-Hodgkin’s lymphomas of the parotid gland). US identification of the specific tumour histotype was quite successful in the case of benign tumours with an accuracy of 84% in pleomorphic adenoma, 93% in adenolymphoma, and 100% in vascular tumours and lipoma. Only 1 of the 17 malignant tumours (a carcinomatous pleomorphic adenoma) was specifically identified. Conclusion: Based on the diagnostic capabilities of US revealed in this study as well as its operational advantages, US is strongly recommended as the first-line imaging procedure for all masses at the SG regions, to be followed by US-guided fine needle aspiration biopsy particularly for equivocal cases.

Objective: To assess the value of ultrasonography (US) in reliably differentiating benign from malignant thyroid nodules, and in defining the malignant nature and the histotype of papillary thyroid carcinomas (PTC). Methods: A high-resolution real-time US system with a 7.5-MHz linear probe was used. The sonographic features of 39 histopathologically proven PTC cases were retrospectively reviewed and compared with the US features of 52 benign thyroid nodules (BTN). The US identification of PTC malignancy was based on the simultaneous presence of multiple US features seen exclusively in PTC and not in BTN. Results: Based on the simultaneous presence of exclusive malignant US features seen in PTC but not in BTN, identification of the malignant nature of PTC was certain in 74% of the cases and less certain in 8% of the cases. In a third group, 15% of the cases showed predominantly benign US features, while 1 patient (3%) was operated as a case of multinodular goiter and diagnosed histologically as having occult PTC. No malignant features were seen by US and it was not associated with metastasis. US identification of the histological type of PTC was based on the finding that a thyroid lesion presenting as a predominant cyst with a punctately calcified endoluminal projecting solid mural nodule was an exclusively specific feature of cystic primary PTC. Both, totally cystic and microcalcified predominantly cystic metastatic lymph nodes were also characteristically seen in metastatic PTC. Accordingly, the histotype of PTC was only identified in its cystic form, whether it was primary (13%) or metastatic (31%). Both constituted 44% of the 39 PTC cases. Conclusion: High-resolution real-time ultrasonography was found to be a useful first line diagnostic modality of PTC. It was reliable in differentiating benign from malignant thyroid nodules and in identifying the histotype of PTC in cases with cystic metastasis or where the primary or the metastatic nodule is cystic with microcalcified projecting solid mural nodule. Fine needle aspiration biopsy is to be resorted to, mainly in equivocal cases.