Mummified Thyroid Nodules: Conventional and Contrast‐Enhanced Ultrasound Features

Abstract

Benign thyroid nodules may display shrinkage over time and may reveal malignant US features. Awareness of these findings and their connection with initial and follow-up US examinations should help identify mummified thyroid nodules and to avoid surgical excision or unnecessary FNA.

Mummified thyroid nodule: a diagnostic and management conundrum

“…1 Various sonographic features of mummified thyroid nodules have been reported, but typically include necrosis associated shrinkage and avascularity, posterior shadowing, as well as regular peripheral black and white halos corresponding to subcapsular granulation tissue and dystrophic eggshell calcifications, respectively. [1][2][3][4] As benign nodules mummify, some of their morphological changes can resemble or mimic malignancy. For example, mummified nodules may demonstrate irregular ill-defined nodule margins due to capsular collapse, taller-than-wide shape from asymmetric fibrous healing with transverse shrinking, replacement of cystic contents with isoto-hypoechoic 'solid' contents due to fibrosis and internal echogenic foci attributed to dystrophic calcifications or colloid material, usually seen in Figure 1 Baseline thyroid ultrasound in October 2017 (A) showed a solitary mixed solid-cystic nodule (denoted n1 on hand drawn diagram) with mild peripheral vascularity, mainly occupying the left lobe with extension into the isthmus.…”

Petal-Like Calcifications in Thyroid Nodules on Ultrasonography: A Rare Morphologic Characteristic of Calcification Associated With Aggressive Biological Behavior

“…The thyroid nodules were imaged with a Siemens Acuson S3000 US scanner equipped with a 9L4 linear array transducer (Siemens Medical Solutions, Mountain View, CA, USA; transducer frequency: 4-9 MHz) and/or an 18L6 linear array transducer (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Petal-like calcifications appeared as scattered hyperechogenic spots < 2 mm in diameter around solid thyroid nodules with the appearance of flower petals and had a cystic-like dark area ahead of each hyperechogenic spot.…”

“…The thyroid nodules with petal-like calcifications often showed acoustic posterior reinforcement. In addition to age, sex, and serum thyroid hormone, which included thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine, thyroid peroxidases antibody (A-TPO), and thyroglobulin antibody (A-TG), the US features of the thyroid nodules were recorded, including tumor size, composition, shape, margin, echogenicity, posterior reinforcement, vascularity, and capsule contact with protrusion (8,9). The US performance of the thyroid nodules was classified according to the Thyroid Imaging Reporting and Data System (TI-RADS) diagnostic classification by Kwak et al (10).…”

“…CEUS videos were recorded for at least 60 s with dedicated software (Contrast Dynamics, Mountain View, CA, USA). With respect to the surrounding thyroid parenchyma enhancement, the timeintensity curves (TICs) of the thyroid nodules with regions of interest (ROIs) were acquired, and CEUS features were classified (8,9), including enhancement type, peak intensity (PI), time to peak (TP), and area under the curve (AUC). The PI, TP, and AUC of the nodules are reported as indices by the ratio of the region of interest in the nodules to the region of interest in the thyroid parenchymal tissue.…”

Contrast-Enhanced Ultrasound of Primary Squamous Cell Carcinoma of the Thyroid: A Case Report

“…Thyroid ultrasonography and fine-needle aspiration biopsy (FNAB) are the diagnostic tools of choice for evaluating patients with suspected thyroid nodules (9). Contrast-enhanced ultrasound (CEUS), as a relatively novel US technique, is used to investigate the microvasculature of thyroid nodules and improve the diagnostic accuracy of thyroid nodules accompanied by the use of Thyroid Imaging Reporting and Data Systems for ultrasonographic features (10)(11)(12)(13). However, very few published studies have reported the use of ultrasonography for ThyPSCC.…”