Sonographic Assessment of Thyroglossal Duct Cysts in Children

Abstract

Abbreviations BCC, branchial cleft cyst; TDC, thyroglossal duct cyst he thyroglossal duct cyst (TDC) is one of the most common congenital neck masses occurring in children, representing approximately 70% of the congenital lesions that occur in the neck. 1,2Sonography is thought to be an ideal initial technique for the differential diagnosis of a neck mass. In the past, the TDC commonly had been known to be a midline anechoic cyst at the level of the hyoid bone.3-6 However, many variations of its sonographic features have been reported. 7,8 As a result, it is important to confirm the existence of a TDC in the differential diagnosis by means of preoperative sonographic examinations, but a correct diagnosis is often difficult to make. As far as we could determine, up to now there have only been 2 statistical investigations (by Wadsworth and Siegel 7 and Ahuja et al 8 ) regarding the sonographic appearance of TDCs in children. We thus thought that an additional investigation should be performed. Therefore, in this study we assessed the sonographic appearance in 36 children with Image PresentationObjective. The purpose of this study was to clarify the sonographic features of thyroglossal duct cysts (TDCs) in children. We also investigated how the presence of inflammation influences the sonographic appearance. Methods. We reviewed the sonograms from 36 children (0.5-14 years old) with pathologically proven TDCs. The lesions were evaluated for location, shape, internal echo pattern, internal septa, wall thickness, posterior enhancement, solid components, margins, and fistulas. The sonographic features of 7 lesions that pathologically showed inflammation were also investigated. Results. Most TDCs were midline (77.8%), were located at the hyoid bone (44.4%) or were infrahyoid (38.9%), showed posterior enhancement (77.8%), were unilocular (86.1%), lacked internal septa (91.7%), and had a thin wall (75%). None had a solid component. The internal echo patterns were classified into 4 types: anechoic (25%), homogeneously hypoechoic (16.7%), pseudosolid (16.7%), and heterogeneous (41.6%). Inflammation was confirmed in 78% of the lesions with wall thickening and 100% of the lesions with internal septa. Conclusions. Most TDCs in children had echogenicity ranging from hypoechoic to heterogeneous. A thick wall and internal septa were considered to correlate with the presence of inflammation but not with the internal echo patterns of TDCs.

Ultrasound to differentiate thyroglossal duct cysts and dermoid cysts in children

“…This is consistent with previous studies identifying TGDC as the most common pediatric anterior neck mass . There was no predilection of these cysts for sex confirming previously published results . There was no difference across groups with respect to age at ultrasound or surgery, which is to be expected given that both lesions are usually excised during childhood, and it has historically been difficult to distinguish between them preoperatively …”

“…Unfortunately, this ultrasound distinction has not been consistent in the literature . Some studies presented conflicting results and others suggested that ultrasound has limited prognostic value . The inability to differentiate between TGDC and DC is problematic to the surgeon because it can result in difficulty consenting patients regarding the extent of surgery as well as planning the length of the operative procedure.…”

A Rare Case Report of a Child Coexistence Thyroglossal Cyst and Second Branchial Cleft Fistulae

“…However, restricted movement of the cyst does not rule out diagnosis. TGDCs may show similarities to dermoid cysts, lymphadenopathy, lymphatic malformations, ectopic thyroid gland, branchial cleft cysts, hemangiomas, lipomas, and sebaceous cysts [6,7]. Thyroglossalduct carcinomas occur in less than 1% of TGDCs [8,9].…”

Comparison of imaging modalities in pediatric thyroglossal duct cysts

“…It has been acknowledged that TDGCs have variable imaging characteristics on US 9. They can range in appearance from anechoic masses to heterogeneous cystic lesions.…”

“…They can range in appearance from anechoic masses to heterogeneous cystic lesions. Previous infection or hemorrhage can influence their appearance greatly 3, 9. In addition, US is an operator‐dependent procedure, and often the interpreting radiologists are not present during the real‐time examination, which may further affect the diagnostic accuracy.…”