PMC9092279_01
Ultrasound and flow chart of Patient #1 after ablation. (A) Preoperative ultrasound of thyroid nodule. (B) Preoperative ultrasound of lymph node. (C) Thyroid FNA smear: epithelial cells with dysplasia (arrow). (D) Cervical lymph node FNA smear: lymphocytes and epithelial cells with dysplasia (arrow). (E, F) Ultrasound after extended ablation of papillary thyroid carcinoma of the right lobe of thyroid of the patient immediately after postoperative (local no contrast medium filling). (G) Two-dimensional ultrasonography of internal jugular vein thrombosis on the second day after ablation. (H) Thrombus flow diagram of the right internal jugular vein on the second day after ablation. (I) One month after thrombolysis, venous thrombosis disappeared, and venous blood flow returned to normal.
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On ultrasound, a hypoechoic nodule of 1.10x0.75x0.63 cm could be seen in the right lobe of the thyroid gland, with irregular shape and unclear boundary (Figure 1A). The larger one was located at the right, with a size of about 1.32x0.63 cm, irregular in shape, an unclear boundary between the dermis and medulla, without hilum (Figure 1B). Biopsy of the thyroid nodule revealed papillary thyroid carcinoma (Figure 1C). Fine-needle aspiration (FNA) of the levels IV and VI lymph nodes revealed lymphocytes and epithelial cells with dysplasia, consistent with lymph node metastasis of papillary thyroid carcinoma (Figure 1D). Postoperative contrast-enhanced ultrasound showed no enhancement of the thyroid nodules after ablation (Figures 1E, F). Heterogeneous hypoechogenicity was observed in the middle and lower segment of the right internal jugular vein, with a length of about 3.56 cm and a width of about 0.50 cm (Figure 1G). A small number of blood flow signals were observed around the hypoechogenic signals (Figure 1H). After thrombolytic therapy (low molecular weight heparin calcium injection 4100 IU, q 12 h, subcutaneous injection, 5 days; Xueshuantong injection 400 mg added into 0.9% sodium chloride injection 250 ml, qd, IVGTT, for 5 days; Xiangdan injection 20 ml added into 5% glucose injection 250 ml, qd, IVGTT, for 5 days; rivaroxaban 15 mg, bid, po, for 7 days), the venous thrombosis disappeared, and venous blood flow had returned to normal at the 1-month reexamination (Figure 1I).
PMC9092279_02
Ultrasound and flow chart of Patient #2 after ablation. (A) Preoperative ultrasound of thyroid nodule. (B) Preoperative ultrasound of lymph node. (C) Ultrasound after extended ablation of papillary thyroid carcinoma of the right lobe of thyroid of the patient immediately after postoperative (local no contrast medium filling). (D) Two-dimensional ultrasonography of internal jugular vein thrombosis on the second day after ablation. (E) Thrombus flow diagram of the right internal jugular vein on the second day after ablation. (F) One week after thrombolysis, venous thrombosis disappeared, and venous blood flow returned to normal.
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Ultrasound of the thyroid showed a hypoechoic nodule of 0.88x0.72x0.76 cm in the right lobe of the thyroid, with an irregular shape, unclear boundary, uneven internal echo, and spot-like strong echo (Figure 2A). Two lymph node lesions could be detected in level IV of the right neck; the larger was about 1.14x0.59 cm, with a regular shape, clear boundary, and uneven internal echo (Figure 2B). Postoperative contrast-enhanced ultrasound showed no enhancement of thyroid nodules after ablation (Figure 2C). Heterogeneous hypoechogenicity was observed in the middle and lower segment of the right internal jugular vein, with a length of about 3.56 cm and a width of about 0.50 cm according to 2D ultrasound and color Doppler ultrasound (Figures 2D, E). After 1 week, the thrombus disappeared, and venous flow was restored (Figure 2F).