PMC4246641_01
Thyroid tuberculosis in a 45-year-old patient. (A) Sonogram image revealing an ovoid-shaped, heterogeneous, hypoechoic nodule with ill-defined margins in the left thyroid lobe, resembling a cystic nodule with fluid space (white arrow). (B) Color Doppler examination revealing punctated and banded flow signals around the nodule.
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An anechoic area with internal hyperechoic spots was present within the mass (Fig. 1A). Color Doppler examination revealed punctate or linear flow signals around the nodule with no intralesional vascularization (Fig. 1B).
Repeat ultrasound examination at three days post-admission. (A) Longitudinal sonograms revealing a nodule, closely adjacent to the left salivary gland and partially protruding from the upper pole of capsular tissue into the left lobe of the thyroid. (B) A blood flow signal can be observed around the nodule. (C) Fine-needle aspiration cytology of the nodule. (D) The aspiration yielded reddish pus that was revealed to be red blood cells with necrosed materials. (E) Follicular epithelial cells on a bloody background, with clusters of purple-stained colloid and a field of red-stained granular caseous necrosis. (F) Multifocal granulomatous nodules inbetween atrophic thyroid follicules, with fibrous tissue proliferation and chronic inflammatory cell infiltration. (E anf F: stain, hematoxylin and eosin; magnification, x200).
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The lesion partially protruded from the upper pole of the left thyroid lobe (Fig. 2A). Blood flow signals were observed by color Doppler examination around, but not inside the lesion (Fig. 2B). A US-guided fine-needle aspiration (FNA) biopsy of the thyroid mass yielded a thick, caseous and bloody material (Fig. 2C and D). Microscopic examination revealed the presence of follicular epithelial cells in flaked or honeycombed formations on a bloody background, together with clusters of purple-stained colloid and a field of granular caseous necrosis (Fig. 2E). Histopathological examination revealed that multifocal granulomatous nodules were distributed in between atrophic thyroid follicles, chronic inflammatory cell infiltration and fibrous tissue proliferation (Fig. 2F).
Repeat ultrasound examination six months after the initiation of anti-tuberculosis medication. (A) Significant shrinkage and echo enhancements can be observed. The nodule is solid and well-defined, with two tiny calcifications inside (white arrows). (B) Color Doppler examination revealing punctate and strip-shaped blood flow around and inside the nodule.
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A repeat US examination was performed six months later without any marked changes in size, but with progressive loss of the definition of the nodule limits (Fig. 3).