Replies to This Discussion

Permalink Reply by Elizabeth Kuntz on January 28, 2010 at 10:55am

We are also not able to optimize well for this examination. We have begun to co-schedule with dual isotope nuclear medicine scan but have not had any "positive" control NM scan to help yet. Does anyone have a protocol with example images and technique examples for inexperienced sonographers that they can recommend to help optimize this examination?

Permalink Reply by Rogerio Augusto Pinto da Silva on March 14, 2010 at 12:38pm

Any hypoechoic nodules, usually with ovoid shape, posterior do thyroid ou below to it in cervical region 7, should be suspicious, specially when there are also clinical or laboratorial findings.
Main differential diagnosis is lymph nodes, which can usually be differentiated by the echogenic hilum or by Color Doppler mapping - parathyroid usually has many peripheral vessels instead of only one in the hilum.
Other difficult differential diagnosis is with posterior colloid nodule, which can be exofitic. Again Color Doppler can be useful in suggesting this possibility.
I usually also use endocavitary probe for mediastinal scanning. It is also helpful to study region I (submandibular) because of rare possibility of ectopic gland.
I have had good results indicating fine needle aspiration of the nodule to measure PTH concentration in needle washings.
Cysts behind the thyroid can also be originated from parathyroid glands. They should be aspirated and PTH measured in the fluid.

Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on March 14, 2010 at 5:33pm

Thank you for the contribution!

Rogerio Augusto Pinto da Silva said:

Any hypoechoic nodules, usually with ovoid shape, posterior do thyroid ou below to it in cervical region 7, should be suspicious, specially when there are also clinical or laboratorial findings.
Main differential diagnosis is lymph nodes, which can usually be differentiated by the echogenic hilum or by Color Doppler mapping - parathyroid usually has many peripheral vessels instead of only one in the hilum.
Other difficult differential diagnosis is with posterior colloid nodule, which can be exofitic. Again Color Doppler can be useful in suggesting this possibility.
I usually also use endocavitary probe for mediastinal scanning. It is also helpful to study region I (submandibular) because of rare possibility of ectopic gland.
I have had good results indicating fine needle aspiration of the nodule to measure PTH concentration in needle washings.
Cysts behind the thyroid can also be originated from parathyroid glands. They should be aspirated and PTH measured in the fluid.

Permalink Reply by Syed Amir Gilani on March 14, 2010 at 5:46pm

the idea of 'Color Doppler mapping - parathyroid usually has many peripheral vessels instead of only one in the hilum.' is apealing.Have you experienced alaising i mean color alaising of any help in this differentiation,try that.

Permalink Reply by Rogerio Augusto Pinto da Silva on March 14, 2010 at 9:42pm

No, I just adjust it to optimize for low flow vessels, with a low PRF and low gain to reduce artifacts. I usually use power doppler or dynamic flow (Toshiba Xario, similar to B-flow)

Syed Amir Gilani said:

the idea of 'Color Doppler mapping - parathyroid usually has many peripheral vessels instead of only one in the hilum.' is apealing.Have you experienced alaising i mean color alaising of any help in this differentiation,try that.

Permalink Reply by Giovanni Illomei on March 28, 2010 at 10:33pm

at aium san diego there was a great presentation on that and as i always say to my collegue you can't see normal parathyroids only when there is a disease is possible to located

Permalink Reply by Syed Amir Gilani on May 20, 2010 at 8:15pm

I use thyroid lower pole as landmark to find parathyroid.I will look if i find any.

Permalink Reply by Dr.UDAYAKUMAR on July 16, 2010 at 8:56pm

Parathyroid adenoma located within the thyroid would be really challenging.
I guess identifying a feeding vessel from inferior thyroidal artery and the arc sign would help.
PTH levels in the washings following aspiration would settle the issue...but is there a less invasive way?
..Dr.Udayakumar. India

Permalink Reply by Rogerio Augusto Pinto da Silva on July 21, 2010 at 3:51pm

Only using Scintigraphy, taht can help in some cases - see: interactive.snm.org/docs/Parathyroid_v3.0.pdf in http://www.google.com/url?sa=t&source=web&cd=1&ved=0CBQ...
Raps

Dr.UDAYAKUMAR said:

Parathyroid adenoma located within the thyroid would be really challenging.
I guess identifying a feeding vessel from inferior thyroidal artery and the arc sign would help.
PTH levels in the washings following aspiration would settle the issue...but is there a less invasive way?
..Dr.Udayakumar. India

Permalink Reply by Dr.Muhammad Bashir Malik on February 17, 2011 at 11:33am

hello forum fellows

Idea to trace parathyroid gland by feeding vessel is not bad but in normal gland even not much helpfull however when there is swlling or mass inside the gland mean size is not palapable can be visulaized posterior to the thyroid gland an oval strwberry shape medium level echogenicity medium to internal jugar vein. After detection with gray scale we can asses pathological process with the help of doppler mean increased vascularity etc.

Some time colloid cyst in posterior aspect of any thyroid lobe may be confused with parathyroid pathology however confirmation is not difficult.

Clinical history and lab findings are not always helpfull but postive clue.