PMC3214490_01
(a,b) Photographs of the 58-year-old man with metastatic follicular thyroid carcinoma showing multiple scalp and facial masses. Note in a and b the tortuous and engorged superficial vessels on the left upper aspect of the face and in (b) the right sided thyroid swelling
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F1
He had an anterior neck swelling to the right side of the midline [Figure 1a] that moved with swallowing.
(a,b) Skull radiographs of the same patient. (a) Occipitofrontal view showing overlapping shadows of the skull masses and masses within the nasal cavity causing ill-definition of the nasal septum. (b) Multiple lytic skull vault lesions with ragged edges and radiating bony stands from the vault into the skull masses. Note the branching lucencies to the direction of the lytic lesion and the overlying masses, suggesting hypervascularity
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F2
Plain skull radiographs [Figure 2a and b] showed multiple lytic skull vault lesions with ragged edges and bony strands extending into the skull masses, from the vault.
Patient chest radiograph showing thyroid mass essentially to the right of midline in the lower aspect of the neck, tracheal deviation to the left, coronal tracheal narrowing and retrosternal extension. Note the hilar soft tissue masses with lobulated margin presumed to be lymphadenopathy
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F3
There was also retrosternal extension and associated mild hilar soft tissue masses with lobulated margins, presumed to be lymphadenopathy [Figure 3].