52-year-old female who is pre-op for right sided parathyroid adenoma. Evaluate for thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.4 x 2.2 x 4.2 cmLEFT LOBE MEASUREMENTS: 2.0 x 2.4 x 4.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: In the right lobe of the thyroid there is an ovoid, hypoechoic nodule measuring 0.6 x 1.2 x 1.3 cm which is nondescript in appearance although there is a suggestion of comet tail artifact as seen with colloid. Review of the prior study demonstrates that this was more cystic in 2013 but unchanged in size measuring 0.8 x 1.2 x 1.3 cm. There is at least one other small simple-appearing cyst as well as.LEFT LOBE: Occupying a significant portion of the left lobe is a large predominantly solid nodule with cystic components measuring 1.9 x 2.5 x 2.7 cm. This has comet tail artifact consistent with colloid. There is difficult to measure on the prior study but this mass was present. Adjacent to this is a smaller 0.8 x 0.9 x 1.1 cm complex cystic nodule with clear comet tail artifact consistent with colloid. This was also present on the prior exam and is not significantly changed in size or appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a large, hypoechoic mass posterior to the right lobe of the thyroid measuring 1 x 1.2 x 2.7 cm consistent with parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Bilateral thyroid nodules. These appear likely to represent colloid nodules.2. Right extrathyroidal mass.US GUIDED FNA, US THYROID; 3/25/2016 10:32 AMCLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Right parathyroid adenoma. Bilateral thyroid nodules.POST-OPERATIVE DIAGNOSIS : Same OPERATORS: Doctors Paushter; I, the attending physician, Dr. Paushter, performed the entire procedure.TECHNIQUE: Following a discussion of the procedure with the patient, including its risks, 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 previously described bilateral nodules.. The skin over the target area was cleansed with chlorhexidine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. RIGHT side: Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 3 fine needle aspirations were performed. Due to capsular deflection of the needle and motion of the nodule, this biopsy was extremely difficult.LEFT side: Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 2 fine needle aspirations were performed.Cytology was present to confirm specimen adequacy. Specimen was handed to cytology. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 5 cc. An adhesive bandage was placed on the patient’s skin.