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What causes solid hypoechoic mass anterior to the jugular vein?

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Practicing since : 2001
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Awaiting news from my doctor about my ultrasound thyroid results. I am most concerned not with the two small hypoechoic 5x3x6 mm and the 6x3x5 mm solid nodules, but with teh 11x4x10mm solid hypoechoic mass most likely a lymph node (reason I went in) anterior to my jugular. I also show a 3 mm septated cyst on the same side (left). I am a nurse, and enlarged painless lymph nodes have me worried (about 6 week duration). I am expecting to be referred to an ENT but is this just too small to worry about?
Posted Sat, 15 Feb 2014 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 51 minutes later
Brief Answer: Thyroid nodules Detailed Answer: Thyroid nodules are fairly common, especially in women and as we grow older. Fortunately about 92 to 95% of these are benign. Do you have any family members with thyroid cancer? Were you ever exposed to radiation to the upper body (like radiation treatment for acne/adenoids or radiation of a head/neck cancer? The above are some risk factors associated with the chance of developing thyroid cancer. If the above are absent, then the nodules less than a centimeter are nothing to worry about. And as you have mentioned you are anyway not concerned about them. Lymph node assessment will depend on the ENT. It would be further useful for the radiologist to give a detailed report on the characteristics of the thyroid nodules, for example commenting on the margins, calcifications, vascularity and if the nodules are taller than wider. Such features give a better idea about the chances of the nodules being malignant. This information will guide the approach to the lymph node evaluation. If the nodules, albeit small, have worrisome characteristics then biopsying both the nodule as well as the lymph node will be a good idea. Often there are ultrasonographic features of lymph nodes that help differentiate between benign versus malignant nodes.
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Follow-up: What causes solid hypoechoic mass anterior to the jugular vein? 15 minutes later
There is nothing about margins, vascularity etc. in the report unfortunately. I noticed what I was pretty sure a swollen lymph node 6 weeks ago or so. Waited until my schedule dr appointment to mention it. It is noticeable and palpable but non tender on my left side, compatible with the reports findings. It has not felt like it has gotten larger yet. I am worried though because it's a lymph node, and not a small thyroid nodule. I can't tell from the measurements (typed exactly how they appear below) if it is oval or round... normally if I were measuring a wound I would do length by width by depth. I don't know if radiologists do the same. I included the whole report below. About 3 weeks ago I started feeling like something was in my throat, not hard to swallow but sometimes like things get stuck. I realize this could be anxiety aside from thyroid issues as well. To say I am concerned that this could be cancer is an understatement. The thyroid portion of the report worries me far less than the lymph node. Other pertinent history for me would be. Found out I was Vitamin D deficient (result 11 in November 2012, likely for years) and I have POTS. I am also a smoker. My grandmother had some kind of thyroid problem, she had it removed and took radioactive iodine in the 1960's. I don't know if it was for a goiter or cancer. My cousin also had papillary carcinoma of the thyroid. I have never had radiation treatments, and had some but not a lot of xray exposure as a nurse working in the ICU and OR. The exact wording in the Impression is this... Tiny septated cyst upper pole left lobe of the thyroid, small subcentimeter hypoechoic solid nodule lower pole right and lower pole left lobe of the thyroid. These l ikely are tiny adenomas. At the are palpable abnormality a 10 x 4 x 11 mm sol nodule (hypoechoic in report part) is present. This is anterior to the left carotid artery. this is likely a lymph node. findings right thyroid size is 5.2x1.9x1.1 cm and left is 3.8x1.8x1.1 cm. the isthymus measures 2.2. mm. in thickness which is normal. in the inferior anterior aspect of the right lobe of the thyroid 5 x 3 x 6 mm hypoechoic solid nodule is present likely a small adenoma. the right lobe is otherwise normal. a 3 mm cyst is seen upper pole left lobe of the thryoid. this contains a thin septation. a 6 x 3 x 5 mm hypoechoic solid nodules present inferior aspect left lobe of the thryoid. this statistically also likely a small adenoma. the palpable area cord and the patien is slightly more laterally situated. there is a hypoechoic solid nodule anterior to the carotid artery measuring 11x10x4 mm . this is likely a small lymph node.
Answered by Dr. Shehzad Topiwala 8 hours later
Brief Answer: Follow up Detailed Answer: I have noted your symptoms and the report. If you have not had your thyroid function checked as yet, I would recommend you get a blood test for TSH and free T4 done. I do not see anything particularly worrisome on the ultrasound but given your family history you would probably want a thorough evaluation of the lymph nodes and possibly the nodules. The decision on the lymph nodes is primarily upto the ENT. However if you choose to FNA biopsy the thyroid nodules then the dual information can be interpreted in conjunction. if your TSH is below normal, you will need to consider doing a Radio active Iodine 123 uptake and scan.
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