Ultrasound of the Central Neck and

Empty Neck

Mira Milas MD, FACS

Professor of Surgery

World Congress on Thyroid Cancer

Toronto, Canada

July 10, 2013

No conflicts of interest or financial relationships to disclose.

Outline and Objectives

•To recognize anatomical boundaries that facilitate

imaging of the central neck and “empty” neck

•To demonstrate the normal components of these

regions

•To illustrate thyroid cancer recurrences and other

pathology in these regions

1. Thyroid

2. Parathyroid (normal or enlarged)

3. Thymus

4. Lymph Nodes (normal or diseased)

5. Fibrofatty tissue (“decorative fat”)

“background”: trachea, esophagus, strap

muscles, paraspinous muscle, vessels, nerves

“unusual”: lesions or tumors of other primaries

Components

of the Central Neck

Central Neck Imaging TriangleThyroid

Thymus

Parathyroid

Lymph node

Fat

Vessels

Correlation of Parathyroid Sonographic

Distribution to Embryologic Origin

The “Empty” Neck

Patient: 44 yo woman with FV PTC

Patient: 24 yo woman with PTC

Patient: 24 yo woman with PTC

Final path

Post-op

Tg 0.3

+TgAB

TSHR mRNA <1

Surgical specimen

PTC 3 cm, right lobe

PTC 1 cm, left lobe

3/9 +LN, central neck

Occasional tall cell

features

No extrathyroidal

extension

Video Gallery

of

Central Neck

and “Empty” Neck

Summary

•Use anatomical knowledge as a framework

for orientation to interpret ultrasound images

of the central neck, in presence or absence

of thyroid gland

Thank You