61-year-old male with a reported history of papillary thyroid carcinoma in 2011, status post thyroidectomy and non-Hodgkin's lymphoma diagnosed in 2013 during lymph node dissection. THYROID: The patient is status post thyroidectomy. RIGHT THYROIDECTOMY BED: Status post thyroidectomy with no evidence of residual or recurrent disease in the right thyroidectomy bed. LEFT THYROIDECTOMY BED: Status post thyroidectomy. Within the inferior left thyroidectomy bed there is a poorly defined 1.4 x 1.3 x 1.3 cm complex hypoechoic focus that is not clearly identified on the prior outside hospital ultrasound images. This may correspond to a cluster of small lymph nodes seen on the outside hospital CT, but this cannot be reliably confirmed given the different modalities. Attention to this area is recommended on subsequent imaging.ISTHMUS BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LYMPH NODES: There are numerous bilateral enlarged cervical lymph nodes at multiple levels. Some of them demonstrate a rounded morphology. No discrete microcalcifications are identified. For future reference, the largest lymph node on the right measures 1.5 x 0.7 x 2.1 cm in superior level II of the neck. One of the regions of the patient's palpable concern is located in the submandibular area and corresponds to a conglomeration of lymph nodes, area measures approximately 2.8 x 1.7 x 2.8 cm.The largest lymph node on the left measures 1.2 x 0.8 x 2.5 cm in mid level III of the neck.
1. Non-specific hypoechoic focus in the inferior left thyroidectomy bed may represent small lymph nodes, as seen on the outside CT exam, however this is equivocal. Attention to this region on subsequent imaging is recommended.2. Increased size and number of bilateral cervical lymph nodes, some of which demonstrate abnormal rounded morphology. This is increased from the prior comparison ultrasound. Discrete intralesional microcalcifications are not identified; for this reason, lymphoma is favored as the etiology of the bilateral lymphadenopathy given the patient's history. 3. The region of palpable concern on the right side of the neck corresponds to a conglomeration of enlarged lymph nodes.