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Chronic Granulomatous Lesions After Thyroidectomy: Imaging Findings

¹ Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St., Philadelphia, PA 19104.
² Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104.
³ Department of Pathology, University of Pennsylvania Medical Center, Philadelphia, PA 19104.

View larger version (90K): [in a new window]   Fig. 1 —47-year-old man (patient 1 in Table 1) who developed palpable left-sided lesion 6 months after thyroidectomy for right 3-mm papillary carcinoma. Transverse sonogram of neck at level just below hyoid shows 6 x 10 x 11 mm hypoechoic lesion with several central echogenic foci in left sternocleidomastoid muscle (large arrow) and similar appearing 5 x 5 x 7 mm lesion in anterior midline subcutaneous tissues (small arrow). Fine-needle aspiration biopsy of both lesions was consistent with granuloma. Repeat sonograms (not shown) obtained 2 years later showed no change in the appearance of these lesions.

View larger version (105K): [in a new window]   Fig. 2 —62-year-old man (patient 2 in Table 1) who underwent thyroidectomy for rightsided 5.4-cm minimally invasive follicular carcinoma presented 29 months after initial surgery with vague palpable abnormality. Transverse sonogram of left neck shows ill-defined lesion measuring 14 x 14 x 42 mm in left sternocleidomastoid muscle that has central hyperechoic focus (arrow). Fine-needle aspiration biopsy was consistent with granuloma. Repeat sonograms (not shown) obtained 19 months later showed no change.

View larger version (92K): [in a new window]   Fig. 3A —57-year-old woman (patient 3 in Table 1) who underwent total thyroidectomy for 4-mm follicular carcinoma with minimal capsular invasion presented 5 years after surgery with palpable abnormality in right neck Axial T2-weighted fat-suppressed fast spin-echo image of neck shows two foci with bright signal: one within right paratracheal region (long arrow) and smaller similar-appearing, more anterior lesion (short arrow) extending into adjacent muscle.

View larger version (114K): [in a new window]   Fig. 3B —57-year-old woman (patient 3 in Table 1) who underwent total thyroidectomy for 4-mm follicular carcinoma with minimal capsular invasion presented 5 years after surgery with palpable abnormality in right neck Axial T1-weighted image after IV gadolinium administration shows ring enhancement of both lesions (arrows). Sonogram obtained at time of fine-needle aspiration (not shown) revealed 17 x 26 x 41 mm complex, partially cystic lesion in right thyroidectomy bed. Surgical excision showed only fibroadipose tissue, necrosis, lymphoid tissue, and both acute and chronic granulomatous inflammation.

View larger version (72K): [in a new window]   Fig. 3C —57-year-old woman (patient 3 in Table 1) who underwent total thyroidectomy for 4-mm follicular carcinoma with minimal capsular invasion presented 5 years after surgery with palpable abnormality in right neck Longitudinal sonogram obtained 18 months after excision of inflammatory lesion shows hypoechoic heterogeneous lesion measuring 18 x 18 x 42 mm that has several internal echogenic foci and smaller adjacent lesion measuring 8 x 12 x 13 mm (not shown).

View larger version (112K): [in a new window]   Fig. 3D —57-year-old woman (patient 3 in Table 1) who underwent total thyroidectomy for 4-mm follicular carcinoma with minimal capsular invasion presented 5 years after surgery with palpable abnormality in right neck Axial contrast-enhanced neck CT scan obtained shortly after C shows hypoattenuating lesion in right paratracheal region (arrow).

View larger version (89K): [in a new window]   Fig. 4 —55-year-old man (patient 4 in Table 1) who had thyroidectomy for right 4-cm follicular variant of papillary carcinoma. Four years earlier patient had granuloma resected from right neck. Five years after thyroidectomy, patient noted left-sided neck lesion. Sonogram shows complex lesion (electronic calipers) measuring 7 x 13 x 16 mm in left sternocleidomastoid muscle that has central markedly echogenic focus surrounded by hypoechoic zone.

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