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Ultrasound of Parathyroid Adenoma

In this radiology lecture, we review the ultrasound appearance of parathyroid adenoma!

Key teaching points include:

Benign tumor of the parathyroid glands
Most common cause of primary hyperparathyroidism: Elevated serum calcium and parathyroid hormone (PTH) levels
Ultrasound: Solid, homogeneous and very hypoechoic. Oval or bean-shaped, long axis oriented craniocaudal. Hypervascular. Majority posterior and inferior to thyroid. Hyperechoic line often separates adenoma from adjacent thyroid. Atypical features: Cystic degeneration, calcification.
Tc-99m sestamibi: Radiotracer uptake persisting on delayed 2-hour images. Taken up by both thyroid and parathyroid tissue, but washes out more rapidly from thyroid. Greater than 90% predictive value for preoperative localization of parathyroid adenoma. SPECT aids with anatomic localization
Ectopic locations in up to 5%: Lower neck, mediastinum, retrotracheal/retroesophageal, carotid sheath and intrathyroidal (typically more homogeneous than thyroid nodules and have a linear interface with gland)
Larger adenomas can be multilobulated
“Polar vessel” sign: Enlarged feeding artery or draining vein terminating at parathyroid adenoma

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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In this radiology lecture, we review the ultrasound appearance of parotitis in the pediatric population!

Key teaching points include:

Parotitis = Inflammation of the parotid glands
Acute parotitis is usually infectious, most commonly viral
Mumps is most common viral cause in children, often bilateral
Bacterial parotitis can cause suppurative parotitis seen in premature infants and immunosuppressed children
Acute parotitis on US: Enlarged, heterogeneous, hyperemic gland(s) +/- lymphadenopathy
Since can be bilateral, comparison scanning essential
Bacterial parotitis may be complicated by abscess
“Pomegranate sign” may be seen in setting of acute parotitis: Uniform anechoic foci scattered throughout the gland
Juvenile recurrent parotitis (JRP) = Recurrent inflammatory parotitis in children of unknown etiology
JRP is rare, but second most common cause of parotitis in childhood after mumps
JRP often begins between age 3-6, typically resolves spontaneously after puberty
Usually idiopathic, JRP can be presenting symptom of Sjogren’s syndrome, lymphoma, and underlying immunodeficiency
JRP on US: May be unilateral or bilateral, multiple hypoechoic foci of salivary secretions scattered throughout the gland +/- central calcifications, color Doppler can be normal
Additional causes of parotitis: Sialolithiasis/obstruction, autoimmune (Sjogren syndrome, chronic sclerosing sialadenitis), infectious (HIV, TB), and sarcoidosis (rare in children).

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

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In this radiology lecture, we review the ultrasound appearance of Hashimoto’s thyroiditis with three unique cases!

Key teaching points include:

Normal thyroid gland isthmus measures less than 0.4 cm, transverse and AP lobe diameters measure less than 2 cm.
Hashimoto’s thyroiditis is an autoimmune thyroiditis caused by antibodies to thyroid proteins.
Most common in middle-aged females.
May coexist with other autoimmune disorders: Lupus, rheumatoid arthritis.
AKA chronic autoimmune lymphocytic thyroiditis: Gland is infiltrated with lymphocytes and plasma cells, fibrotic reaction replaces normal parenchyma.
Leads to hypothyroidism = Most common cause in USA.
Increased risk of thyroid cancer, including thyroid lymphoma.
On ultrasound, gland is normal-sized or enlarged in initial phase with heterogeneously hypoechoic parenchymal echotexture.
May have hypoechoic micronodules (1-6 mm) yielding a “pseudonodular” or “giraffe” pattern = High positive predictive value.
Can also present with thin echogenic fibrous strands, lobulated contour, and geographic hypoechogenicity without discrete nodules.
Gland may be atrophic in chronic cases.
Variable color Doppler flow, may be hypervascular.
Reactive, morphologically-normal neck nodes may be present.
Can be difficult to differentiate from other forms of thyroiditis on ultrasound.
Laboratory/serologic diagnosis: Thyroid function tests (TSH, free T4 test), thyroid peroxidase (TPO) antibodies present in most (95%) patients, and antithyroglobulin antibodies.
Treatment: Thyroid hormone replacement if hypothyroid.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

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Aneurysm Diameter	Imaging Interval
<2.0 cm	Yearly follow-up is recommended; follow-up interval may be extended depending on comorbidities and life expectancy
≥2.0 cm	Endovascular therapy should be considered

“Splenic artery aneurysms occur more frequently in women.”
“Risk factors associated with rupture include rapidly increasing size, occurrence in women of childbearing years, cirrhosis (especially associated with α1 antitrypsin deficiency), and symptoms that can be attributable to the aneurysm.”
“Smaller aneurysms probably can be safely followed, although the clinical risk factors for rupture should be carefully assessed.”

Reference: Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings. J Am Coll Radiol 2013;10:789-794.