Multiple endocrine neoplasia type 2 echocardiography or ultrasound: Difference between revisions
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{{Multiple endocrine neoplasia type 2}} | {{Multiple endocrine neoplasia type 2}} | ||
{{CMG}}; {{AE}} {{Ammu}} | {{CMG}}; {{AE}} {{Ammu}} | ||
==Overview== | ==Overview== | ||
[[Ultrasound]] scan may be helpful in the [[diagnosis]] of multiple endocrine neoplasia type 2. Findings on [[ultrasound]] scan suggestive of multiple endocrine neoplasia type 2 include punctate high echogenic foci resembling [[calcification]] within the [[thyroid gland]], solid to mixed [[cystic]] masses on [[adrenal gland]], and homogeneously hypoechoic [[parathyroid gland]]. | |||
==Ultrasound== | ==Ultrasound== | ||
===Medullary Thyroid Carcinoma=== | ===Medullary Thyroid Carcinoma=== | ||
* Punctate high echogenic foci resembling calcification may be seen both within the primary thyroid lesion as well as metastatic regional lymph | * Punctate high echogenic foci resembling [[calcification]] may be seen both within the primary [[thyroid]] lesion as well as [[metastatic]] regional [[lymph node]]s and distant [[Metastasis|metastatic]] sites. Involved [[lymph node]]s typically calcify.<ref name="pmid3538147">{{cite journal| author=Gorman B, Charboneau JW, James EM, Reading CC, Wold LE, Grant CS et al.| title=Medullary thyroid carcinoma: role of high-resolution US. | journal=Radiology | year= 1987 | volume= 162 | issue= 1 Pt 1 | pages= 147-50 | pmid=3538147 | doi=10.1148/radiology.162.1.3538147 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3538147 }} </ref> | ||
===Pheochromocytoma=== | ===Pheochromocytoma=== | ||
* Pheochromocytoma can have a variable appearance ranging from solid to mixed cystic and solid to cystic<ref name="pmid23345359">{{cite journal| author=Leung K, Stamm M, Raja A, Low G| title=Pheochromocytoma: the range of appearances on ultrasound, CT, MRI, and functional imaging. | journal=AJR Am J Roentgenol | year= 2013 | volume= 200 | issue= 2 | pages= 370-8 | pmid=23345359 | doi=10.2214/AJR.12.9126 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345359 }} </ref><ref name=Radiopaedia | * [[Pheochromocytoma]] can have a variable appearance ranging from solid to mixed [[cystic]] and solid to [[Cyst|cystic]] masses.<ref name="pmid23345359">{{cite journal| author=Leung K, Stamm M, Raja A, Low G| title=Pheochromocytoma: the range of appearances on ultrasound, CT, MRI, and functional imaging. | journal=AJR Am J Roentgenol | year= 2013 | volume= 200 | issue= 2 | pages= 370-8 | pmid=23345359 | doi=10.2214/AJR.12.9126 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345359 }} </ref><ref name="Radiopaedia">{{cite web | title = Radiopedia 2015 Pheochromocytoma [Dr Matt A. Morgan and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/pheochromocytoma-2 }}</ref> | ||
===Parathyroid Adenoma=== | ===Parathyroid Adenoma=== | ||
* Ultrasound is one of most commonly used initial imaging modalities. | * [[Ultrasound]] is one of most commonly used initial imaging modalities. | ||
* Most nodules need to be >1cm to be confidently seen on [[ultrasound]]. | |||
* [[Parathyroid adenoma]]s tend to be homogeneously hypoechoic to the overlying [[thyroid gland]]. | |||
* An echogenic [[thyroid]] capsule separating the [[thyroid]] from the [[parathyroid]] may be seen.<ref name="pmid20614300">{{cite journal| author=Wieneke JA, Smith A| title=Parathyroid adenoma. | journal=Head Neck Pathol | year= 2008 | volume= 2 | issue= 4 | pages= 305-8 | pmid=20614300 | doi=10.1007/s12105-008-0088-8 | pmc=PMC2807581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20614300 }} </ref><ref name="pmid17515397">{{cite journal| author=Johnson NA, Tublin ME, Ogilvie JB| title=Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 | pages= 1706-15 | pmid=17515397 | doi=10.2214/AJR.06.0938 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515397 }} </ref> | |||
* '''Doppler [[ultrasound]]''' | |||
* Doppler ultrasound | :* May commonly show a characteristic extrathyroidal feeding vessel (typically a branch of [[Inferior thyroid artery|inferior thyroidal artery]]), which enters the [[parathyroid gland]] at one of the poles. Internal [[vascularity]] is also commonly observed in a peripheral distribution. This feeding [[artery]] tends to branch around the periphery of the [[gland]] before penetration. This feature gives a characteristic arc or rim of [[vascularity]]. The overlying [[thyroid gland]] may also show an area of asymmetric hypervascularity that may help to locate an underlying [[adenoma]].<ref name="Radiopaedia">{{cite web | title = Radiopedia 2015 Parathyroid adenoma [Dr Bruno Di Muzio and Dr Yuranga Weerakkody]| url = http://radiopaedia.org/articles/parathyroid-adenoma }}</ref> | ||
:* | |||
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Latest revision as of 02:46, 27 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Ultrasound scan may be helpful in the diagnosis of multiple endocrine neoplasia type 2. Findings on ultrasound scan suggestive of multiple endocrine neoplasia type 2 include punctate high echogenic foci resembling calcification within the thyroid gland, solid to mixed cystic masses on adrenal gland, and homogeneously hypoechoic parathyroid gland.
Ultrasound
Medullary Thyroid Carcinoma
- Punctate high echogenic foci resembling calcification may be seen both within the primary thyroid lesion as well as metastatic regional lymph nodes and distant metastatic sites. Involved lymph nodes typically calcify.[1]
Pheochromocytoma
- Pheochromocytoma can have a variable appearance ranging from solid to mixed cystic and solid to cystic masses.[2][3]
Parathyroid Adenoma
- Ultrasound is one of most commonly used initial imaging modalities.
- Most nodules need to be >1cm to be confidently seen on ultrasound.
- Parathyroid adenomas tend to be homogeneously hypoechoic to the overlying thyroid gland.
- An echogenic thyroid capsule separating the thyroid from the parathyroid may be seen.[4][5]
- Doppler ultrasound
- May commonly show a characteristic extrathyroidal feeding vessel (typically a branch of inferior thyroidal artery), which enters the parathyroid gland at one of the poles. Internal vascularity is also commonly observed in a peripheral distribution. This feeding artery tends to branch around the periphery of the gland before penetration. This feature gives a characteristic arc or rim of vascularity. The overlying thyroid gland may also show an area of asymmetric hypervascularity that may help to locate an underlying adenoma.[3]
References
- ↑ Gorman B, Charboneau JW, James EM, Reading CC, Wold LE, Grant CS; et al. (1987). "Medullary thyroid carcinoma: role of high-resolution US". Radiology. 162 (1 Pt 1): 147–50. doi:10.1148/radiology.162.1.3538147. PMID 3538147.
- ↑ Leung K, Stamm M, Raja A, Low G (2013). "Pheochromocytoma: the range of appearances on ultrasound, CT, MRI, and functional imaging". AJR Am J Roentgenol. 200 (2): 370–8. doi:10.2214/AJR.12.9126. PMID 23345359.
- ↑ 3.0 3.1 "Radiopedia 2015 Pheochromocytoma [Dr Matt A. Morgan and Dr Frank Gaillard]".
- ↑ Wieneke JA, Smith A (2008). "Parathyroid adenoma". Head Neck Pathol. 2 (4): 305–8. doi:10.1007/s12105-008-0088-8. PMC 2807581. PMID 20614300.
- ↑ Johnson NA, Tublin ME, Ogilvie JB (2007). "Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism". AJR Am J Roentgenol. 188 (6): 1706–15. doi:10.2214/AJR.06.0938. PMID 17515397.