 RIGHT LOBE MEASUREMENTS: 5.8 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 6.0 x 2.6 x 4.5 cmISTHMUS MEASUREMENTS: 7 mmRIGHT LOBE: Multiple predominantly subcentimeter nodules are present. Spongiform 7 x 5 x 8 mm interpolar nodule is unchanged. Within the inferior pole in the posterior aspect of the gland is a 1.3 x 1.1 x 0.7 cm solid nodule with small cystic components with a spongiform appearance. No increased vascularity or calcifications. The margins are relatively well defined. LEFT LOBE: The left thyroid lobe is mostly replaced by a 4.8 x 2.3 x 4.1 cm complex predominantly isoechoic solid nodule. No suspicious calcifications or hypervascularity. The nodule margins are relatively well-defined.ISTHMUS: Heterogeneously thickened isthmus.PARATHYROID GLANDS: No parathyroid adenoma candidate was visualized.FINE NEEDLE ASPIRATION REPORT:OPERATORS: Doctors Patel and Trilisky; The attending physician, Dr. Patel, was present for theentire procedure.TECHNIQUE: Following a discussion of the procedure with the patient, including its risks (pain, bleeding, infection, and adequate sample), benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated at the target dominant 1.3-cm inferior left pole posteriorly located nodule. The skin over the target area was cleansed with Betadine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. Using aseptic technique, and continuous ultrasound guidance, several attempts were made to aspirate the nodule, however, the patient expressed significant discomfort during the procedure in-spite of additional local anesthetic, the deep location of the nodule made visualization difficult and the medial to lateral approach was complicated by the patient's musculature. The procedure was discontinued with the patient's consent before adequate sampling was obtained. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 1 cc. An adhesive bandage was placed on the patient’s skin.
1.Multinodular goiter. The dominant left nodule was reportedly previously biopsied and confirmed to be a colloid nodule. The dominant right 1.3 cm nodule has a spongiform appearance and is felt to most likely represent a colloid nodule.2.Attempted ultrasound guided fine needle aspiration of the dominant left 1.3 cm nodule was unsuccessful due to the deep location of the nodule limiting visibility and patient discomfort as described above.