Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Review Article

Ultrasound Imaging of Cervical Anatomic Variants

Author(s): Michael Cordes*, Stephan Coerper, Torsten Kuwert and Christian Schmidkonz

Volume 17, Issue 8, 2021

Published on: 27 January, 2021

Page: [966 - 972] Pages: 7

DOI: 10.2174/1573405617666210127162328

open_access

Abstract

Embryologic developmental variants of the thyroid and parathyroid glands may cause cervical anomalies that are detectable in ultrasound examinations of the neck. For some of these developmental variants, molecular genetic factors have been identified. Ultrasound, as the first-line imaging procedure, has proven useful in detecting clinically relevant anatomic variants. The aim of this article was to systematically summarize the ultrasound characteristics of developmental variants of the thyroid and parathyroid glands as well as ectopic thymus and neck cysts. Quantitative measures were developed based on our findings and the respective literature. Developmental anomalies frequently manifest as cysts that can be detected by cervical ultrasound examinations. Median neck cysts are the most common congenital cervical cystic lesions, with a reported prevalence of 7% in the general population. Besides cystic malformations, developmental anomalies may appear as ectopic or dystopic tissue. Ectopic thyroid tissue is observed in the midline of the neck in most patients and has a prevalence of 1/100,000 to 1/300,000. Lingual thyroid accounts for 90% of cases of ectopic thyroid tissue. Zuckerkandl tubercles (ZTs) have been detected in 55% of all thyroid lobes. Prominent ZTs are frequently observed in thyroid lobes affected by autoimmune thyroiditis compared with normal lobes or nodular lobes (P = 0.006). The correct interpretation of the ultrasound characteristics of these variants is essential to establish the clinical diagnosis. In the preoperative assessment, the identification of these cervical anomalies via ultrasound examination is indispensable.

Keywords: Cervical anomalies, cervical cysts, thyroid anomalies, parathyroid gland anomalies, cervical ultrasound, zuckerkandl tubercles (ZTs).

Graphical Abstract
[1]
Muktyaz H, Birendra Y, Dhiraj S, et al. Anatomical variations of thyroid gland and its clinical significance in North Indian population. Global J Biol Agric Health Sci 2013; 2: 12-6.
[2]
Dessie MA. Anatomical variations and developmental anomalies of the thyroid gland in Ethiopian population: a cadaveric study. Anat Cell Biol 2018; 51(4): 243-50.
[http://dx.doi.org/10.5115/acb.2018.51.4.243] [PMID: 30637158]
[3]
Suzuki S, Midorikawa S, Fukushima T, et al. Thyroid examination unit of the radiation medical science center for the fukushima health management survey. Systematic determination of thyroid volume by ultrasound examination from infancy to adolescence in Japan: the Fukushima Health Management Survey. Endocr J 2015; 62(3): 261-8.
[http://dx.doi.org/10.1507/endocrj.EJ14-0478] [PMID: 25735879]
[4]
Aydıner Ö, Karakoç Aydıner E, Akpınar İ, Turan S, Bereket A. Normative data of thyroid volume-ultrasonographic evaluation of 422 subjects aged 0-55 years. J Clin Res Pediatr Endocrinol 2015; 7(2): 98-101.
[http://dx.doi.org/10.4274/jcrpe.1818] [PMID: 26316430]
[5]
Duarte GC, Araujo LMQ, Magalhães F, Almada CM, Cendoroglo MS. Ultrasonographic assessment of thyroid volume in oldest-old individuals. Arch Endocrinol Metab 2017; 61(3): 269-75.
[http://dx.doi.org/10.1590/2359-3997000000223] [PMID: 27901180]
[6]
Chaudhary P, Singh Z, Khullar M, Arora K. Levator glandulae thyroideae, a fibromusculoglandular band with absence of pyramidal lobe and its innervation: a case report. J Clin Diagn Res 2013; 7(7): 1421-4.
[http://dx.doi.org/10.7860/JCDR/2013/6144.3186] [PMID: 23998080]
[7]
Gaikwad S, Joshi R. An anatomical study of morphological variations of the thyroid gland. Int Journ Anat Res 2016; 4: 2665-9.
[http://dx.doi.org/10.16965/ijar.2016.297]
[8]
Wang C. The anatomic basis of parathyroid surgery. Ann Surg 1976; 183(3): 271-5.
[http://dx.doi.org/10.1097/00000658-197603000-00010] [PMID: 1259483]
[9]
Mirilas P, Skandalakis JE. Zuckerkandl’s tubercle: Hannibal ad Portas. J Am Coll Surg 2003; 196(5): 796-801.
[http://dx.doi.org/10.1016/S1072-7515(02)01831-8] [PMID: 12742214]
[10]
Nilsson M, Fagman H. Development of the thyroid gland. Development 2017; 144(12): 2123-40.
[http://dx.doi.org/10.1242/dev.145615] [PMID: 28634271]
[11]
Samar D, Kieler JB, Klutts JS. Identification and deletion of Tft1, a predicted glycosyltransferase necessary for cell wall β-1,3;1,4-glucan synthesis in Aspergillus fumigatus. PLoS One 2015; 10(2): e0117336.
[http://dx.doi.org/10.1371/journal.pone.0117336] [PMID: 25723175]
[12]
Ohuchi H, Hori Y, Yamasaki M, et al. FGF10 acts as a major ligand for FGF receptor 2 IIIb in mouse multi-organ development. Biochem Biophys Res Commun 2000; 277(3): 643-9.
[http://dx.doi.org/10.1006/bbrc.2000.3721] [PMID: 11062007]
[13]
Hazard JB. The C cells (parafollicular cells) of the thyroid gland and medullary thyroid carcinoma. A review. Am J Pathol 1977; 88(1): 213-50.
[PMID: 18012]
[14]
Johansson E, Andersson L, Örnros J, et al. Revising the embryonic origin of thyroid C cells in mice and humans. Development 2015; 142(20): 3519-28.
[http://dx.doi.org/10.1242/dev.126581] [PMID: 26395490]
[15]
Liu Z, Yu S, Manley NR. Gcm2 is required for the differentiation and survival of parathyroid precursor cells in the parathyroid/thymus primordia. Dev Biol 2007; 305(1): 333-46.
[http://dx.doi.org/10.1016/j.ydbio.2007.02.014] [PMID: 17382312]
[16]
Supakul N, Delaney LR, Siddiqui AR, Jennings SG, Eugster EA, Karmazyn B. Ultrasound for primary imaging of congenital hypothyroidism. AJR Am J Roentgenol 2012; 199(3): W360-6.
[http://dx.doi.org/10.2214/AJR.11.7905] [PMID: 22915427]
[17]
Schneider C, Dietlein M, Faust M, Drzezga A, Schmidt M. Thyroid hemiagenesis is combined with a variety of thyroid disorders. Nucl Med (Stuttg) 2019; 58(3): 265-71.
[http://dx.doi.org/10.1055/a-0830-4425] [PMID: 30974469]
[18]
Dighe M, Barr R, Bojunga J, et al. Thyroid ultrasound: state of the art part 1 - thyroid ultrasound reporting and diffuse thyroid diseases. Med Ultrason 2017; 19(1): 79-93.
[http://dx.doi.org/10.11152/mu-980] [PMID: 28180201]
[19]
Mauriello C, Marte G, Canfora A, et al. Bilateral benign multinodular goiter: What is the adequate surgical therapy? A review of literature. Int J Surg 2016; 28(Suppl. 1): S7-S12.
[http://dx.doi.org/10.1016/j.ijsu.2015.12.041] [PMID: 26708850]
[20]
Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE. German Society for General and Visceral Surgery. Indication of surgical management of benign goiter in adults. Dtsch Arztebl Int 2018; 115(1-02): 1-7.
[http://dx.doi.org/10.3238/arztebl.2018.0001] [PMID: 29345225]
[21]
Kos M. Head and neck congenital malformations. Acta Clin Croat 2004; 43: 195-201.
[22]
Gandhi A, Wong KK, Gross MD, Avram AM. Lingual thyroid ectopia: diagnostic SPECT/CT imaging and radioactive iodine treatment. Thyroid 2016; 26(4): 573-9.
[http://dx.doi.org/10.1089/thy.2015.0396] [PMID: 26864253]
[23]
Fiaschetti V, Claroni G, Scarano AL, Schillaci O, Floris R. Diagnostic evaluation of a case of lingual thyroid ectopia. Radiol Case Rep 2016; 11(3): 165-70.
[http://dx.doi.org/10.1016/j.radcr.2016.04.004] [PMID: 27594942]
[24]
Pelizzo MR, Toniato A, Gemo G. Zuckerkandl’s tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg 1998; 187(3): 333-6.
[http://dx.doi.org/10.1016/S1072-7515(98)00160-4] [PMID: 9740193]
[25]
Lee TC, Selvarajan SK, Curtin H, Mukundan S. Zuckerkandl tubercle of the thyroid: a common imaging finding that may mimic pathology. AJNR Am J Neuroradiol 2012; 33(6): 1134-8.
[http://dx.doi.org/10.3174/ajnr.A2914] [PMID: 22300934]
[26]
Page C, Cuvelier P, Biet A, Boute P, Laude M, Strunski V. Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies. J Laryngol Otol 2009; 123(7): 768-71.
[http://dx.doi.org/10.1017/S0022215108004003] [PMID: 19000342]
[27]
Hisham AN, Aina EN. Zuckerkandl’s tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence? Aust N Z J Surg 2000; 70(4): 251-3.
[http://dx.doi.org/10.1046/j.1440-1622.2000.01800.x] [PMID: 10779054]
[28]
Brown RE, Harave S. Diagnostic imaging of benign and malignant neck masses in children-a pictorial review. Quant Imaging Med Surg 2016; 6(5): 591-604.
[http://dx.doi.org/10.21037/qims.2016.10.10] [PMID: 27942480]
[29]
Gilmour JR. The embryology of the parathyroid glands, the thymus and certain associated rudiments. J Pathol 1937; 45: 507-22.
[http://dx.doi.org/10.1002/path.1700450304]
[30]
Bang MH, Shin J, Lee KS, et al. Intrathyroidal ectopic thymus in children: A benign lesion. Medicine (Baltimore) 2018; 97(14): e0282.
[http://dx.doi.org/10.1097/MD.0000000000010282]
[31]
Kabaalioğlu A, Öztek MA, Kesimal U, Çeken K, Durmaz E, Apaydın A. Intrathyroidal ectopic thymus in children: a sonographic survey. Med Ultrason 2017; 19(2): 179-84.
[http://dx.doi.org/10.11152/mu-913] [PMID: 28440352]
[32]
Durmaz E, Barsal E, Parlak M, et al. Intrathyroidal ectopic thymic tissue may mimic thyroid cancer: a case report. J Pediatr Endocrinol Metab 2012; 25(9-10): 997-1000.
[http://dx.doi.org/10.1515/jpem-2012-0207] [PMID: 23426832]
[33]
Buła G, Waler J, Niemiec A, Mucha R, Gawrychowski J. Lateral and median cysts of the neck. Pol Przegl Chir 2012; 84(9): 445-8.
[PMID: 23241572]
[34]
Mondin V, Ferlito A, Muzzi E, et al. Thyroglossal duct cyst: personal experience and literature review. Auris Nasus Larynx 2008; 35(1): 11-25.
[http://dx.doi.org/10.1016/j.anl.2007.06.001] [PMID: 17720342]
[35]
Chang KV, Wu WT, Özçakar L. Thyroglossal duct cyst: dynamic ultrasound evaluation and sonoanatomy revisited. Med Ultrason 2019; 21(1): 99-100.
[http://dx.doi.org/10.11152/mu-1879] [PMID: 30779840]
[36]
Chou J, Walters A, Hage R, et al. Thyroglossal duct cysts: anatomy, embryology and treatment. Surg Radiol Anat 2013; 35(10): 875-81.
[http://dx.doi.org/10.1007/s00276-013-1115-3] [PMID: 23689821]
[37]
Ibrahim M, Hammoud K, Maheshwari M, Pandya A. Congenital cystic lesions of the head and neck. Neuroimaging Clin N Am 2011; 21(3): 621-639, viii.
[http://dx.doi.org/10.1016/j.nic.2011.05.006] [PMID: 21807315]
[38]
Valentino M, Quiligotti C, Carone L. Branchial cleft cyst. J Ultrasound 2013; 16(1): 17-20.
[http://dx.doi.org/10.1007/s40477-013-0004-2] [PMID: 24046795]
[39]
Adams A, Mankad K, Offiah C, Childs L. Branchial cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings. Insights Imaging 2016; 7(1): 69-76.
[http://dx.doi.org/10.1007/s13244-015-0454-5] [PMID: 26661849]
[40]
Harnsberger HR, Mancuso AA, Muraki AS, et al. Branchial cleft anomalies and their mimics: computed tomographic evaluation. Radiology 1984; 152(3): 739-48.
[http://dx.doi.org/10.1148/radiology.152.3.6463255] [PMID: 6463255]
[41]
Ahuja AT, King AD, Metreweli C. Second branchial cleft cysts: variability of sonographic appearances in adult cases. AJNR Am J Neuroradiol 2000; 21(2): 315-9.
[PMID: 10696015]

© 2024 Bentham Science Publishers | Privacy Policy