Neck ultrasound

Where to do an ultrasound of the neck, who is prescribed this procedure, and how the examination is carried out, we will consider these issues. Ultrasound examination of the neck means examination of the salivary ligaments, thyroid gland, vocal cords, lymph nodes and duplex diagnostics of the vessels of the neck. Of course, all these studies are multidirectional and independent in terms of diagnostics. But they are all united under the general name - ultrasound of the neck. Let's consider in more detail each of the types of ultrasound included in the ultrasound of the neck:

• Ultrasound of the neck vessels is performed to assess vascular patency, blood flow velocity, and to identify blood clots and atherosclerotic plaques, which may be a factor in the development of a stroke.
• Ultrasound of the vessels of the neck and head is prescribed to patients suffering from frequent dizziness, strokes, ischemic attacks, periodic loss of consciousness and other disorders of blood flow in the brain.
• Ultrasound of the lymph nodes - during the examination, the doctor examines the cervical lymph nodes, inflammation or enlargement of which indicates the presence of a disease.
• Thyroid ultrasound – during diagnostics, the doctor evaluates the location of the organ, shape, size of the lobes, structure, total volume of the gland, presence or absence of nodes.

Indications for ultrasound of the neck

1. Palpable mass in the neck area.
2. Pathology of the carotid arteries (rough noise, symptoms of insufficiency). In this case, a Doppler study is necessary to establish an accurate diagnosis.

Ultrasound cannot completely exclude the presence of parathyroid adenoma.

Preparation

1. Patient preparation. No special preparation is required.
2. Patient position. The patient should lie on his back with a pillow placed under the shoulders. The pillow should be approximately 10 cm thick. Apply the gel randomly to the neck.
3. Selecting a probe: Use a 7.5 MHz linear probe if possible; if not available, use a 5 MHz linear or convex probe.
4. Sensitivity adjustment: Change the sensitivity level until you get the optimal image of the scanned areas.

Scanning technique

It is necessary to obtain cuts in both longitudinal and transverse and oblique directions.

During the examination, if necessary, you can turn your head to the side, especially for examining blood vessels.

Normal neck anatomy on ultrasound

During ultrasound examination of the neck area, the following normal anatomical structures are differentiated:

• Carotid arteries.
• Jugular veins.
• Thyroid gland.
• Trachea.
• Surrounding muscles.

It is essential that all structures are visualized during the examination.

Vessels. The vascular bundle (carotid artery and jugular vein) is defined behind and between the sternocleidomastoid muscle, along the lateral contour of the thyroid gland. The vessels are well visualized by ultrasound examination.

The carotid artery, which divides into the internal and external carotid arteries, is visualized as tubular structures with hyperechoic walls and an anechoic lumen: the walls are usually smooth, the vessel is difficult to compress when pressed by the sensor. The jugular veins are located lateral to the carotid arteries and are easily compressed. The veins vary significantly in diameter during the respiratory cycle and during the Valsalva maneuver.

Thyroid gland. The thyroid gland consists of two lobes located on either side of the trachea, connected by a midline isthmus. Both lobes and the isthmus have the same, homogeneous echostructure, while the lobes are approximately the same in size. On cross-sections, the lobes have a triangular shape; on longitudinal sections, they are oval. The contour of the gland should be smooth and clear.

The transverse size of the thyroid gland is 15-20 mm, width - 20-25 mm, length - 30-50 mm.

Muscles. The examination of the sternocleidomastoid muscle is extremely important in children. The muscle is a ribbon-like structure, less echogenic than thyroid tissue. When scanning transversely, the muscle contour is very well defined, but the shape of the section changes from round to oval.

Lymph nodes. Normal lymph nodes may be visualized as hypoechoic structures less than 1 cm in diameter.

Thyroid pathology

Pathological changes in the thyroid gland can be diffuse or focal; foci can be single or multiple.

Focal changes

1. Solid. About 70% of focal changes are thyroid nodules. About 90% of the nodules are adenomas, which are very rarely malignant. The echographic picture of adenomas varies significantly, and it is impossible to differentiate between a benign thyroid adenoma and a malignant tumor: their echostructure may be the same. The diameter of the formations is not a differential diagnostic feature. Both benign and malignant tumors can be hypo- and hyperechoic; both can have a cystic component. However, if the tumor has a clear outline and a thin anechoic rim, there is a 95% probability of a benign adenoma. In the presence of central necrosis, there is a probability of a malignant process.
2. Cysts. True thyroid cysts are rare. They usually have a smooth and clear outline, an anechoic cavity, except in cases where hemorrhage occurs into the cyst cavity.
3. Hemorrhage or abscess in the thyroid gland occurs and appears as a cystic or mixed echogenic structure with an unclear outline.
4. Calcification. Echography reveals hyperechoic areas with a distal acoustic shadow. Calcification is most often detected in thyroid adenomas, but can also occur in malignant tumors. Calcifications can be single or multiple, located in chains or groups. It is important to remember that the size of the node, as well as the presence or absence of calcifications, are not differential diagnostic signs of malignancy or benignity of the process (X-ray examination also does not provide additional information).

An enlarged thyroid gland with internal calcification may or may not be malignant. Neither sonography nor radiography determines whether the tumor is malignant or benign.

Diffuse changes in the thyroid gland

Enlarged thyroid gland with homogeneous echostructure

The thyroid gland may be enlarged, sometimes extending retrosternally. The enlargement may involve only part of the lobe, the entire lobe, the isthmus, or both lobes. The enlargement is most often caused by hyperplasia, and the structure may be uniform on echographic examination. This may be endemic goiter due to iodine deficiency, hyperplasia of puberty, thyrotoxicosis, or vicarious hyperplasia after thyroid resection. A small, uniform gland of reduced echogenicity may be seen in acute thyroiditis.

Enlarged thyroid gland with heterogeneous echostructure

If the thyroid gland enlargement is accompanied by heterogeneity of the echostructure, this is usually due to multiple nodes (multinodular goiter); the nodes may be solid or have mixed echogenicity on echography. In autoimmune thyroiditis, the thyroid gland structure becomes heterogeneous and can simulate multinodular goiter.

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Other formations in the neck area

Echography is a valuable method for differentiating formations in the neck area, determining their shape, consistency, size, extent and relationship to the thyroid gland and vascular trunks. The etiology of these formations cannot always be determined.

Abscesses

The size and shape of neck abscesses vary considerably, and the outline of the abscess is often unclear and uneven. Ultrasound examination often reveals an internal echo structure. In children, the abscess is most often localized in the retropharyngeal space.

Lymphadenopathy

Diagnosis of enlarged cervical lymph nodes is usually performed by clinicians, but echography is an excellent method of dynamic observation. During echography, lymph nodes appear as hypoechoic formations with clear contours, single or multiple, oval or round, of various diameters larger than 1 cm. Using echography, it is impossible to determine the cause of enlarged lymph nodes.

Cystic hygromas (lymphangioma of the neck)

They are of varying sizes, located in the lateral areas of the neck, and may extend to the chest and axillary region. On sonography, they appear as fluid-containing structures, often with septa.

Rare Neck Formations

In children, the echogenic formation may be a hematoma. Among the neck muscles with a cystic or mixed echogenicity structure, there may be a thyroglossal cyst (median neck cyst), a cyst from elements of the embryonic branchial cleft (lateral neck cyst) or a dermoid.

Vascular pathology

Using ultrasound, it is possible to detect atherosclerotic plaques and stenosis of the carotid arteries, but blood flow can only be determined using Doppler ultrasound and, in many cases, angiography.

Complete obstruction of the carotid artery can only be diagnosed by Doppler ultrasound examination.

Ultrasound scanning of the neck does not require special preparation, so it is considered one of the most convenient examinations that can be carried out at any time. As a rule, ultrasound is performed by a surgeon and an endocrinologist, since these specialists are engaged in the diagnosis and treatment of neck diseases.