Image of a nodule with peripheral calcifications and acoustic shadowing that obscures its central content. According to the ACR TI-RADS, when the internal characteristics of a nodule cannot be determined because of acoustic shadowing, it is prudent to assume that it is solid and to assign it 2 points for composition, as well as 1 point for echogenicity. In this case, the nodule was assigned 2 points for being of indeterminate composition, 1 point for being of indeterminate echogenicity, 0 points for being wider-than-tall, 2 points for having lobulated margins, and 2 points for having peripheral calcifications. Therefore, the total score was 7 points and the risk level was classified as TR5.