Файловый архив студентов. Файловый архив студентов.
1327 вузов, 5482 предметов.
/ Регистрация
FAQ Обратная связь Вопросы и предложения
Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Ростовский Государственный Медицинский Университет
Предмет:
Медицина общая
Файл:
Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5770_Библиотеки_им_академика_М_И_Перельмана.pdf
Скачиваний:
0
Добавлен:
30.08.2026
Размер:
64 Мб
Скачать
☆
►Содержание►
bc
11 Sonography ofMajor Salivary Glands
a
249
Fig. 11.36 (a) B-mode ultrasound of parotid gland carcinoma shows an
inhomogeneous intra-parotideal lesion with irregular borders, which appears with irregular hard areas in strain elastography. (b) Slight vessel
pleomorphic adenoma [2]. Adenoid cystic carcinomas show striking differences from other parotid gland carcinomas. The growth pattern of adenoid cystic carcinoma is rather slow, but perineural invasion can frequently be seen and results in a higher proportion of facial nerve palsy at the time of diagnosis [2]. Hematogenous metastases (particularly pul­monary metastases) occur frequently, whereas lymphatic metastatic spread is infrequent. Therefore, pulmonary and abdominal CT scan is a mandatory part of the initial and follow-up staging [2].
Overall, facial nerve palsy can be diagnosed in 8% of all patients with parotid gland malignancy, with a pronounced occurrence in squamous cell carcinomas and their metasta-
formation is visualized in color-coded duplex sonography, (c) Contrast enhanced ultrasound shows hyperperfused and hypoperfused areas. The white line outlines the parotid gland; the red line indicates the tumor
ses [2]. Preoperative ultrasonographic identication of sali­vary gland malignancy is of major clinical impact in managing the balancing act between sufcient radicality and a minimum of facial nerve alteration. Irregular tumor bor­ders, missing acoustic enhancement, and the occurrence of cervical lymph nodes in B-mode ultrasound—as well as irregular (“chaotic”) vessel formation in color-coded duplex sonography—are highly suspicious for salivary gland malig­nancy (Fig.11.36) [3, 52, 54]. Inhomogeneous elastography visualizing a mixture of hard and soft areas (“garland sign”) occurs signicantly more often in salivary gland malignancy (Fig.11.36a). The impact of shear-wave techniques is dis­cussed controversially [54, 66]. Unfortunately, the vast
250
ab
Fig. 11.37 Color-coded duplex sonography (a) and axial CT scan (b) of intra-parotideal metastasis of cutaneous squamous cell carcinoma. Color-
coded duplex sonography shows an inhomogeneous, hypoechoic tumor with well-dened borders and capsular vascularity
A. Knopf
majority of salivary gland carcinoma does not demonstrate a “typical” ultrasonographic appearance and will be underdi­agnosed [3, 52, 54]. In these cases, hypoperfusion in CEUS of hypervascularized tumors after CDS (and vice versa) can often be attributed to malignant lesions (Fig. 11.36b, c). CEUS as part of an ultrasonography-based algorithm signi­cantly improves diagnostic sensitivity and specicity in the identication of salivary gland cancer, but it is not part of today’s sonography routine [3, 52, 54, 67–69]. Therefore, the occurrence of ipsilateral cervical lymph nodes, parotid gland masses with a history of ipsilateral cutaneous malignancy, irregular tumor borders, and facial nerve alteration are highly suspicious for salivary gland malignancy (Fig.11.37) [3, 54].
Lymphoma
Manifestations of major salivary gland lymphoma can be seen in both mucosa-associated lymphoid tissue and parotid gland lymph nodes [1–3, 17]. The parotid gland represents the most frequent tumor site, where lymphoma accounts for approximately 3% of all lesions [2]. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tis­sue (MALT) lymphoma represent the most frequent entities [2, 3]. Glandular MALT lymphoma often refers to Sjögren’s syndrome [11, 17, 70]. Patients with Sjögren’s syndrome have a 44-fold increased risk of developing salivary or extra­salivary lymphoma, 48–75% of which cases are MALT lym­phoma [71]. There is a broad ultrasonographic appearance of salivary gland lymphoma. Some lymphomas show B-mode characteristics of benign or malignant parotid gland lesions. Others can be diagnosed as enlarged intra-parotideal lymph node or are hidden in lymphoepithelial lesions of Sjögren’s syndrome (Fig.11.38). Interestingly, facial nerve alteration is a rare event [2]. Open biopsy and “diagnostic” subman-
dibulectomy and parotidectomy are the diagnostic approaches of choice because of the lack of specicity of symptoms and ultrasonographic ndings and the broad variety of differen­tial diagnoses.
11.6 Pseudotumors ofMajor Salivary Glands
A few types of inammatory, dysontogenetic, and neoplastic lesions can be clinically mistaken for major salivary gland tumors. Some of these lesions originate in salivary gland structures; others refer to circumjacent tissue. The lesions most often misinterpreted as salivary gland tumors represent lymph nodes originating in level I or IIa. Limited space between the oor of the mouth, the mandible, and the sub­mandibular gland impede rough differentiation between a submandibular gland tumor and level I cervical lymph nodes [3]. B-mode assessment of the relative contact between the lesion and the submandibular gland can give a rough esti­mate of the lesional origin [3]. Tumors with less than 40% relative contact with the submandibular gland (referring to the entire tumor circumference) are cervical lymph nodes than submandibular gland tumors (Fig.11.39) [3]. In some cases, CDS clearly identies hilar vessel formation or vascu­larization apart from the submandibular gland, suggesting lymph node disease (Fig.11.40). In addition, tumor masses in level IIa must be differentiated as eccentric Warthin’s tumor or cervical lymph node (Fig.11.41) [58]. Unfortunately, Warthin’s tumor shares many B-mode and CDS criteria with cervical lymph nodes, so sonographic differentiation may be illusive at this point. Tumor diagnosis is based on total extir­pation, with awareness of the necessity of extracapsular dis-
ab
11 Sonography ofMajor Salivary Glands
251
Fig. 11.38 (a) Color-coded duplex sonography shows grade 3
Sjögren’s syndrome of the right parotid gland, with septal hypervascu­larity referring to mucosa-associated lymphoma. (b) Diffuse large
Fig. 11.39 Color-coded duplex sonography demonstrates the relative
contact between the lesion (white line) and the submandibular gland (red line), referring to its own circumferences. Relative contact less
B-cell lymphoma (DLBCL) is visualized echo-free with well-dened borders and slight hilus vascularization
than 40% (left) refers to an extra-glandular lymph node; more than 40% (right) refers to a submandibular gland tumor
section. Application of continuous neuromonitoring might be suitable in these cases [58].
Another lesion in level IIa/b that requires differentiation is the rst branchial cleft cyst. Second to fourth branchial cleft cysts represent typical differential diagnoses of head and neck masses, but rst branchial cleft cysts occur infre­quently [72]. B-mode ultrasound demonstrates a hypoechoic or echo-free lesion in the caudal and deep part of the parotid gland, superiorly lying on the posterior belly of the digastric muscle (Fig.11.42) [73]. Intralesional macrovascularization and microvascularization are absent. Ductal structures pass­ing the gland profound to the facial nerve often fail to be
diagnosed (Fig.11.43) [73]. An extension into the parapha­ryngeal space can be diagnosed with MRI, which is indi­cated when cysts are not fully visualized via ultrasound (Fig.11.44).
Vessel-associated disease, including hemangioma, lymphangioma, and vessel malformation, also shows mani­festations in the parotid region or submandibular triangle. In B-mode ultrasound, hemangioma shows hypoechoic lesions sometimes resembling lipoma. CDS visualization ranges from a low-ow pattern to striking hypervascularity due to the underlying vessel supply (Fig.11.45). Though hemangi­oma appears hard on palpation, lymphangioma and vessel
252
ab
cd
Fig. 11.40 Color-coded duplex sonography visualizes hilus vessel supply via facial vein branches (left), suggesting a level Ib lymph node.
Irregular submandibular gland vascularization (right) refers to submandibular gland adenoid cystic carcinoma
A. Knopf
Fig. 11.41 Differential diagnoses of parotid gland pseudo-tumors. (a)
Eccentric Warthin’s tumor is visualized in B-mode ultrasound as an inhomogeneous tumor with well-dened borders. (b) Color-coded duplex sonography shows peripheral and central hypervascularity. (c) In the same region, B-mode ultrasound visualized non-Hodgkin lym-
phoma as an echo-free tumor with well-dened borders. (d) Color­coded duplex sonography excludes branchial cleft cyst, but eccentric Warthin’s tumor remains a potential differential diagnosis. PBDM pos­terior belly of the digastric muscle, PG parotid gland
ab
ab
ab
11 Sonography ofMajor Salivary Glands
Fig. 11.42 B-mode ultrasound of a rst branchial cleft cyst shows an echo-free lesion in the caudal and profound part of the parotid gland (a)
without perfusion in contrast-enhanced ultrasound (b). PBDM posterior belly of the digastric muscle, PG parotid gland
253
Fig. 11.43 (a) Intraoperative situs in surgery for extirpation of a rst branchial cleft cyst (white dotted line). Shown are the duct (black arrow),
facial nerve (black star), and the supercial temporal artery (white arrow). (b) Extirpated rst branchial cleft cyst. DM digastric muscle [73]
Fig. 11.44 (a) Color-coded duplex sonography demonstrates avascular, echo-free lesion of the left parotid gland that cannot be completely visual-
ized by ultrasound. (b) Corresponding coronal MRI shows parapharyngeal extension of a rst branchial cleft cyst. JA jaw angle
254
ab
ab
Fig. 11.45 Hemangioma. (a) B-mode ultrasound shows an inhomogeneous tumor of the parotid gland capsule. (b) Strong hypervascularity is
seen in color-coded duplex sonography
A. Knopf
Fig. 11.46 Submandibular lymphangioma. (a) B-mode ultrasound shows an echo-free tumor with intralesional septa. (b) Color-coded duplex
sonography excludes intralesional vascularization. FA facial artery, mmh mylohyoid muscle
malformation appear soft. Both show echo-free areas in B-mode ultrasound, with differing extent of intralesional septa [74]. Though CDS fails to visualize vascularization in lymphangioma (Fig.11.46), the acquisition of a valid vascu­larization pattern can be difcult in vessel malformation, particularly in venous low-ow variants. In these cases, contrast- enhanced ultrasound shows vessel perfusion with
high sensitivity (Fig.11.47). However, angio-MRI should be performed to exclude deep neck extension (Fig.11.48) [75].
Masseter muscle hypertrophy also represents a pseudo­tumor of the parotid gland that is usually associated with dysgnathia. B-mode ultrasound reveals unilateral or bilateral masseter muscle hypertrophy without any glandular pathol­ogy (Fig.11.49).
ab
cd
ab
11 Sonography ofMajor Salivary Glands
255
Fig. 11.47 Vessel malformation. (a) B-mode ultrasound visualized
this submandibular low-ow vessel malformation as an echo-free lesion with intralesional septa comparable to those of lipoma. (b) Color-coded duplex sonography fails to visualize lesional vascularity. (c) Early-
phase contrast-enhanced ultrasound does not show lesional perfusion. (d) Late-phase contrast-enhanced ultrasound visualizes perfusion by facial vein (FV) supply. FA facial artery, SMG submandibular gland
Fig. 11.48 (a) Color-coded duplex sonography demonstrates an avascular, echo-free lesion of cavernous hemangioma that cannot be completely
visualized by ultrasound. (b) Corresponding coronal angio-MRI demonstrates broad transcervical extension
256
Fig. 11.49 B-mode sonography of masseter muscle hypertrophy in the
pre-auricular region, profound to the parotid gland (white line). MM masseter muscle

References

1. Hofauer B, Chaker A, Strenger T, Bas M, Mansour N, Knopf A.Swelling of the submandibular and parotid glands: a description of possible differential diagnoses. HNO. 2016;64:333–48. German.
2. Knopf A, Szyper M, Mansour N, Sonnenberg J, Hofauer B, Niedermeyer H.A critical review of 20 years of parotid gland sur­gery. Acta Otolaryngol. 2016;136:711–6.
3. Knopf A, Cortolezis N, Bas M, Mansour N, Hofauer B.Multimodal ultrasonographic algorithm in the differentiation of submandibular masses. Acta Otolaryngol. 2017;137:640–5.
4. Zengel P, Schrotzlmair F, Reichel C, Paprottka P, Clevert DA. Sonography: the leading diagnostic tool for diseases of the salivary glands. Semin Ultrasound CT MR. 2013;34:196–203.
5. Lee YY, Wong KT, King AD, Ahuja AT.Imaging of salivary gland tumours. Eur J Radiol. 2008;66:419–36.
6. Christe A, Waldherr C, Hallett R, Zbaeren P, Thoeny H.MR imag­ing of parotid tumors: typical lesion characteristics in MR imag­ing improve discrimination between benign and malignant disease. AJNR Am J Neuroradiol. 2011;32:1202–7.
7. Milic VD, Petrovic RR, Boricic IV, Marinkovic-Eric J, Radunovic GL, Jeremic PD, etal. Diagnostic value of salivary gland ultrasono­graphic scoring system in primary Sjögren’s syndrome: a compari­son with scintigraphy and biopsy. J Rheumatol. 2009;36:1495–500.
8. Cornec D, Jousse-Joulin S, Saraux A, Devauchelle-Pensec V. Salivary gland ultrasound to diagnose Sjögren’s syndrome: a claim to standardize the procedure. Rheumatology (Oxford). 2015;54:199–200.
9. Rudack C, Jörg S, Kloska S, Stoll W, Thiede O.Neither MRI, CT nor US is superior to diagnose tumors in the salivary glands--an extended case study. Head Face Med. 2007;3:19.
10. de Ru JA, van Leeuwen MS, van Benthem PP, Velthuis BK, Sie-Go DM, Hordijk GJ.Do magnetic resonance imaging and ultrasound add anything to the preoperative workup of parotid gland tumors? J Oral Maxillofac Surg. 2007;65:945–52.
11. Knopf A, Bas M, Chaker A, Strassen U, Pickhard A, Stark T, etal. Rheumatic disorders affecting the head and neck: underestimated diseases. Rheumatology (Oxford). 2011;50:2029–34.
12. Lakshmi NM, Azeem Mohiyuddin SM, Mohammadi K, Devnikar AV, Prasad KN.Parotid abscess in children– a tertiary rural hospi­tal experience. Int J Pediatr Otorhinolaryngol. 2015;79:1988–90.
13. Terraz S, Poletti PA, Dulguerov P, Dfouni N, Becker CD, Marchal F, Becker M.How reliable is sonography in the assessment of sialo­lithiasis? AJR Am J Roentgenol. 2013;201:W104–9.
A. Knopf
14. Francis CL, Larsen CG.Pediatric sialadenitis. Otolaryngol Clin N Am. 2014;47:763–78.
15. Wilson KF, Meier JD, Ward PD.Salivary gland disorders. Am Fam Physician. 2014;89:882–8.
16. Hofauer B, Chaker A, Thurmel K, Knopf A.Manifestations of auto­immune disorders in otorhinolaryngology: classical symptoms and diagnostic approach. HNO. 2017;65:695–708.
17. Knopf A, Hofauer B, Thürmel K, Meier R, Stock K, Bas M, Manour N.Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjoegren’s syndrome. Eur Radiol. 2015;25:3027–34.
18. Knopf A, Lahmer T, Chaker A, Stark T, Hofauer B, Pickhard A, et al. Head and neck sarcoidosis, from wait and see to tumor necrosis factor alpha therapy: a pilot study. Head Neck. 2013;35:715–9.
19. Carsons S.A review and update of Sjögren’s syndrome: manifesta­tions, diagnosis, and treatment. Am J Manag Care. 2001;7:S433–43.
20. Patel R, Shahane A.The epidemiology of Sjögren’s syndrome. Clin Epidemiol. 2014;6:247–55.
21. Makula E, Pokorny G, Rajtar M, Kiss I, Kovacs A, Kovacs L. Parotid gland ultrasonography as a diagnostic tool in primary Sjögren’s syndrome. Br J Rheumatol. 1996;35:972–7.
22. Makula E, Pokorny G, Kiss M, Voros E, Kovacs L, Kovacs A, etal. The place of magnetic resonance and ultrasonographic examina­tions of the parotid gland in the diagnosis and follow-up of primary Sjögren’s syndrome. Rheumatology (Oxford). 2000;39:97–104.
23. Hocevar A, Ambrozic A, Rozman B, Kveder T, Tomsic M.Ultrasonographic changes of major salivary glands in primary Sjögren’s syndrome. Diagnostic value of a novel scoring system. Rheumatology (Oxford). 2005;44:768–72.
24. Hofauer B, Mansour N, Heiser C, Gahleitner C, Thuermel K, Bas M, Knopf A.Sonoelastographic modalities in the evaluation of sali­vary gland characteristics in Sjögren’s syndrome. Ultrasound Med Biol. 2016;42:2130–9.
25. Mansour N, Hofauer B, Knopf A.Ultrasound elastography in dif­fuse and focal parotid gland lesions. ORL J Otorhinolaryngol Relat Spec. 2017;79:54–64.
26. Hofauer B, Mansour N, Heiser C, Wirth M, Strassen U, Loeffelbein D, et al. Reproducibility of Acoustic Radiation Force Impulse imaging in thyroid and salivary glands with experienced and inex­perienced examiners. Ultrasound Med Biol. 2016;42:2545–52.
27. Mulholland GB, Jeffery CC, Satija P, Cote DW.Immunoglobulin G4-related diseases in the head and neck: a systematic review. J Otolaryngol Head Neck Surg. 2015;44:24.
28. Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, etal. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344:732–8.
29. Kleger A, Seufferlein T, Wagner M, Tannapfel A, Hoffmann TK, Mayerle J.IgG4-related autoimmune diseases: polymorphous pre­sentation complicates diagnosis and treatment. Dtsch Arztebl Int. 2015;112:128–35.
30. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association man­agement guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid Cancer. Thyroid. 2016;26:1–133.
31. Epstein JB, Thariat J, Bensadoun RJ, Barasch A, Murphy BA, Kolnick L, et al. Oral complications of cancer and cancer ther­apy: from cancer treatment to survivorship. CA Cancer J Clin. 2012;62:400–22.
32. Baum BJ, Bodner L, Fox PC, Izutsu KT, Pizzo PA, Wright WE.Therapy-induced dysfunction of salivary glands: implications for oral health. Spec Care Dentist. 1985;5:274–7.
33. Lee HN, An JY, Lee KM, Kim EJ, Choi WS, Kim DY. Salivary gland dysfunction after radioactive iodine (I-131) therapy in patients following total thyroidectomy: emphasis on radioactive iodine therapy dose. Clin Imaging. 2015;39:396–400.
11 Sonography ofMajor Salivary Glands
257
34. Jeong SH, Hong HS, Lee EH.Diagnostic utility of acoustic structure quantication for evaluation of radiation sialadenitis after radioac­tive iodine therapy. Ultrasound Med Biol. 2016;42:2553–61.
35. Badea AF, Tamas SA, Ciuleanu E, Chioreanu I, Baciut G, Lupsor PM, Badea R.ARFI quantitative elastography of the submandibu­lar glands. Normal measurements and the diagnosis value of the method in radiation submaxillitis. Med Ultrason. 2013;15:173–9.
36. Badea I, Tamas-Szora A, Chiorean I, Crisan M, Ciuleanu E, Baciut G, Badea M.Acoustic Radiation Force Impulse quantitative elas­tography: a new noninvasive technique for the evaluation of parotid glands. A preliminary study in controls and in patients with irradi­ated nasopharyngeal carcinoma. Med Ultrason. 2015;17:308–14.
37. Zengel P, Reichel CA, Vincek T, Clevert DA.Ultrasound elastogra­phy in diagnosis and follow-up for patients with chronic recurrent parotitis. Clin Hemorheol Microcirc. 2017;67:389–97.
38. Sanan A, Cognetti DM.Rare parotid gland diseases. Otolaryngol Clin N Am. 2016;49:489–500.
39. Koch M, Iro H, Zenk J.Stenosis and other non-sialolithiasis-related obstructions of the major salivary gland ducts. Modern treatment concepts. HNO. 2010;58:218–24.
40. Zenk J, Iro H, Klintworth N, Lell M.Diagnostic imaging in sialad­enitis. Oral Maxillofac Surg Clin North Am. 2009;21:275–92.
41. Katz P, Hartl DM, Guerre A.Clinical ultrasound of the salivary glands. Otolaryngol Clin N Am. 2009;42:973–1000.
42. Zengel P, Schrotzlmair F, Schwarz F, Paprottka P, Kramer M, Berghaus A, Clevert DA.Elastography: a new diagnostic tool for evaluation of obstructive diseases of the salivary glands; primary results. Clin Hemorheol Microcirc. 2012;50:91–9.
43. Zengel P, Berghaus A, Weiler C, Reiser M, Clevert DA.Intraductally applied contrast-enhanced ultrasound (IA-CEUS) for evaluat­ing obstructive disease and secretory dysfunction of the salivary glands. Eur Radiol. 2011;21:1339–48.
44. Vinayachandran D, Sankarapandian S. Salivary duct cyst: histo­pathologic correlation. J Clin Imaging Sci. 2013;3:3.
45. Dumitriu D, Dudea SM, Botar-Jid C, Baciut G. Ultrasonographic and sonoelastographic features of pleomorphic adenomas of the salivary glands. Med Ultrason. 2010;12:175–83.
46. Pinkston JA, Cole P. Incidence rates of salivary gland tumors: results from a population-based study. Otolaryngol Head Neck Surg. 1999;120:834–40.
47. Biorklund A, Eneroth CM. Management of parotid gland neo­plasms. Am J Otolaryngol. 1980;1:155–67.
48. Drivas EI, Skoulakis CE, Symvoulakism EK, Bizaki AG, Lachanas VA, Bizakis JG. Pattern of parotid gland tumors on Crete, Greece: a retrospective study of 131 cases. Med Sci Monit. 2007;13:CR136–40.
49. Seifert G, Hennings K, Caselitz J.Metastatic tumors to the parotid and submandibular glands--analysis and differential diagnosis of 108 cases. Pathol Res Pract. 1986;181:684–92.
50. Bialek EJ, Jakubowski W, Zajkowski P, Szopinski KT, Osmolski A. US of the major salivary glands: anatomy and spatial rela­tionships, pathologic conditions, and pitfalls. Radiographics. 2006;26:745–63.
51. Bialek EJ, Jakubowski W, Karpinska G.Role of ultrasonography in diagnosis and differentiation of pleomorphic adenomas: work in progress. Arch Otolaryngol Head Neck Surg. 2003;129:929–33.
52. Knopf A, Mansour N, Chaker A, Bas M, Stock K. Multimodal ultrasonographic characterisation of parotid gland lesions--a pilot study. Eur J Radiol. 2012;81:3300–5.
53. Mansour N, Stock KF, Chaker A, Bas M, Knopf A.Evaluation of parotid gland lesions with standard ultrasound, color duplex sonog­raphy, sonoelastography, and acoustic radiation force impulse imaging– a pilot study. Ultraschall Med. 2012;33:283–8.
54. Mansour N, Bas M, Stock KF, Strassen U, Hofauer B, Knopf A.Multimodal ultrasonographic pathway of parotid gland lesions. Ultraschall Med. 2017;38:166–73.
55. Klintworth N, Mantsopoulos K, Zenk J, Psychogios G, Iro H, Bozzato A. Sonoelastography of parotid gland tumours: initial
experience and identication of characteristic patterns. Eur Radiol. 2012;22:947–56.
56. Matsuzuka T, Suzuki M, Saijo S, Ikeda M, Matsui T, Nomoto Y, et al. Stiffness of salivary gland and tumor measured by new ultrasonic techniques: virtual touch quantication and IQ. Auris Nasus Larynx. 2015;42:128–33.
57. Mantsopoulos K, Koch M, Klintworth N, Zenk J, Iro H.Evolution and changing trends in surgery for benign parotid tumors. Laryngoscope. 2015;125:122–7.
58. Knopf A, Heiser C, Karasoy O, Hofauer B, Bier H, Mansour N. Bipolar dissection technique in parotid gland surgery. Acta Otolaryngol. 2017;137:1210–4.
59. Teymoortash A, Werner JA, Moll R. Is Warthin’s tumour of the parotid gland a lymph node disease? Histopathology. 2011;59:143–5.
60. Teymoortash A, Werner JA.Tissue that has lost its track: Warthin’s tumour. Virchows Arch. 2005;446:585–8.
61. Seifert G, Bull HG, Donath K.Histologic subclassication of the cystadenolymphoma of the parotid gland. Analysis of 275 cases. Virchows Arch A Pathol Anat Histol. 1980;388:13–38.
62. Strassen U, Hofauer B, Jacobi C, Knopf A.Management of locore­gional recurrence in cutaneous squamous cell carcinoma of the head and neck. Eur Arch Otorhinolaryngol. 2017;274:501–6.
63. Knopf A, Bas M, Hofauer B, Mansour N, Stark T.Clinicopathological characteristics of head and neck Merkel cell carcinomas. Head Neck. 2017;39:92–7.
64. Franzen A, Buchali A, Lieder A.The rising incidence of parotid metastases: our experience from four decades of parotid gland sur­gery. Acta Otorhinolaryngol Ital. 2017;37:264–9.
65. Bradley PJ.Frequency and histopathology by site, major pathol­ogies, symptoms and signs of salivary gland neoplasms. Adv Otorhinolaryngol. 2016;78:9–16.
66. Zengel P, Notter F, Reichel CA, Clevert DA.Does Virtual Touch IQ elastography help to improve the preoperative diagnosis of parotid tumors: a prospective trial. Clin Hemorheol Microcirc. 2017;67:425–34.
67. Badea AF, Bran S, Tamas-Szora A, Floares A, Badea R, Baciut G.Solid parotid tumors: an individual and integrative analysis of various ultrasonographic criteria. A prospective and observational study. Med Ultrason. 2013;15:289–98.
68. Abdel Razek AA, Ashmalla GA, Gaballa G, Nada N.Pilot study of ultrasound parotid imaging reporting and data system (PIRADS): inter-observer agreement. Eur J Radiol. 2015;84:2533–8.
69. Wei X, Li Y, Zhang S, Li X, Wang H, Yong X, et al. Evaluation of microvascularization in focal salivary gland lesions by contrast­enhanced ultrasonography (CEUS) and Color Doppler sonography. Clin Hemorheol Microcirc. 2013;54:259–71.
70. Ambrosetti A, Zanotti R, Pattaro C, Lenzi L, Chilosi M, Caramaschi P, et al. Most cases of primary salivary mucosa­associated lymphoid tissue lymphoma are associated either with Sjoegren syndrome or hepatitis C virus infection. Br J Haematol. 2004;126:43–9.
71. Kassan SS. Immunogenetics of Sjögren’s syndrome. Ann Med Interne (Paris). 1998;149:45–8.
72. D’Souza AR, Uppal HS, De R, Zeitoun H. Updating concepts of rst branchial cleft defects: a literature review. Int J Pediatr Otorhinolaryngol. 2002;62:103–9.
73. Gahleitner C, Scherer E, Knopf A.A specic type of cyst. HNO. 2013;61:958–60.
74. Sun RW, Tuchin VV, Zharov VP, Galanzha EI, Richter GT.Current status, pitfalls and future directions in the diagnosis and therapy of lymphatic malformation. J Biophotonics. 2017. https://doi.
org/10.1002/jbio.201700124. [Epub ahead of print].
75. Guneyli S, Ceylan N, Bayraktaroglu S, Gucenmez S, Aksu K, Kocacelebi K, etal. Imaging ndings of pulmonary granulomato­sis with polyangiitis (Wegener’s granulomatosis): lesions invading the pulmonary ssure, pleura or diaphragm mimicking malignancy. Wien Klin Wochenschr. 2016;128:809–15.
Ultrasound oftheThyroid Gland
TomislavNovosel andPeterJecker
12
12.1 Introduction: TheThyroid Examination
To simplify the thyroid ultrasound (US) examination and to make it more practical and systematic (according to thyroid ultrasound features), it is reasonable to group the examina­tion into two parts: the general thyroid examination and spe­cial thyroid examination.
Before using US to go deep into thyroid problems, it is important to have a general overview. The rst step should be to measure the thyroid size (width, length, height). While obtaining these measurements, the examiner will acquire the rst impression of the thyroid: Is it normal in size, small, or enlarged? Is it substernal? Does it have nodules? Is the thy­roid tissue homogenous or heterogeneous? On the basis of these ndings, it is possible to start to diagnose pathology.
A more thorough, special thyroid US examination is important to completely evaluate thyroid nodules, to nd the presence or absence of pretracheal and paratracheal lymph nodes, and to perform elastography of thyroid nodules.
A substantial US report regarding thyroid nodules should always begin with the position of the nodules in the thyroid: the upper pole, the lower pole, the middle third of the thy­roid, or the isthmus. To complete the evaluation, the follow­ing US characteristics should be considered [1, 2]:
• The number of nodules in the thyroid
• The size of each nodule
Electronic Supplementary Material The online version of this chap­ter (https://doi.org/10.1007/978-3-030-12641-4_12) contains supple­mentary material, which is available to authorized users.
T. Novosel (*) ∙ P. Jecker Department of Otorhinolaryngology and Plastic Head and NeckSurgery, Klinikum Bad Salzungen GmbH, Bad Salzungen, Germany e-mail: Tomislav.novosel@klinikum-badsalzungen.de
• The echogenicity of the nodules (hypoechoic, hyper­echoic, isoechoic, anechoic, homogeneous, heteroge­neous, cystic, solid, posterior enhancement, spongiform)
• The presence of calcication (microcalcications, coarse calcications, peripheral rim calcication [eggshell phenomenon])
• The form of the nodules (round, oval, irregular, “taller­than- wide” phenomenon)
• Regularity of the borders
• Halo effect
• Comet-tail sign
• Vascularization of the nodules (peripheral ring of ow, internal ow)
Thyroid US can also estimate the nature of lymph nodes
surrounding thyroid. The appearance and form of lymph nodes suggest whether they might be suspicious. Oval lymph nodes with hilum represent benign lymph nodes, whereas lymph nodes without hilum and with extensive internal ow are very suspicious and must be further inves­tigated by performing ne needle aspiration biopsy [3]. It is not usual to nd lymph nodes in the pretracheal or para­tracheal compartment, so it is essential to investigate all lymph nodes found in this area. But it should be expected to nd such lymph nodes in patients with autoimmune thy­roid disease (Hashimoto thyroiditis); the characteristics of Hashimoto thyroiditis are discussed in a later section of this chapter.
A relatively new US method to help distinguish soft
from hard thyroid nodules is elastography. Soft nodules are more likely to have a benign etiology, whereas hard nodules have a higher rate of malignancy [4]. Elastography findings alone are not currently enough to make a deci­sion about surgery, but it is a helpful diagnostic tool to decide whether fine needle aspiration biopsy should be performed.
© Springer Nature Switzerland AG 2019 H. J. Welkoborsky, P. Jecker (eds.), Ultrasonography of the Head and Neck, https://doi.org/10.1007/978-3-030-12641-4_12
259
Соседние файлы в папке Библиотека им академика М.И. Перельмана
Помощь Обратная связь Вопросы и предложения Пользовательское соглашение Политика конфиденциальности