Ultrasound of the neck

Where to make an ultrasound of the neck, who is prescribed this procedure, and how the study is going, we will consider these questions. The ultrasound examination of the neck involves the study of salivary ligaments, thyroid gland, vocal cords, lymph nodes and duplex diagnosis of the vessels of the neck. Of course, all these studies are multidirectional and independent in terms of diagnosis. But they are all united under the common name - ultrasound of the neck. Let's consider more in detail each kind of ultrasound included in the US of the neck:

• Ultrasound of the neck vessels - is performed to assess vascular patency, blood flow velocity, to detect thrombi and atherosclerotic plaques, which can be a factor in the development of stroke.
• Ultrasound of the vessels of the neck and head - prescribed for patients suffering from frequent dizziness, stroke, ischemic attacks, with periodic loss of consciousness and other disorders of blood flow in the brain.
• Ultrasound of the lymph nodes - in the course of the study the doctor studies the cervical lymph nodes, the inflammation or enlargement of which indicates the presence of the disease.
• Ultrasound of the thyroid gland - during the diagnosis the doctor assesses the location of the organ, shape, size of lobes, structure, total gland volume, presence or absence of nodes.

Indications for ultrasound of the neck

1. Palpable formation in the neck.
2. Pathology of carotid arteries (gross noise, symptoms of insufficiency). At the same time it is necessary to conduct a dopplerographic study to establish an accurate diagnosis.

Echography can not completely exclude the presence of adenoma of the parathyroid glands.

Preparation

1. Preparation of the patient. Special training is not required.
2. Position of the patient. The patient should lie on his back with a small pillow under his shoulders. The cushion should be about 10 cm thick. Apply the gel arbitrarily on the neck.
3. Select the sensor. Use as far as possible a linear 7.5 MHz sensor; if not, use a linear or convection 5 MHz sensor.
4. Sensitivity adjustment. Change the sensitivity level until the optimum image of the scanned areas is obtained.

Scanning techniques

It is necessary to obtain sections both in the longitudinal, transverse and oblique directions.

During the study, if necessary, you can turn your head on your side, especially for the study of blood vessels.

Normal anatomy of the neck on ultrasound

With echography in the neck, the following normal anatomical structures differentiate:

• Sleepy arteries.
• Jugular veins.
• Thyroid.
• Trachea.
• The surrounding muscles.

It is necessary that all structures be visualized during the study.

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

The carotid artery dividing into the inner and outer carotid arteries is visualized as tubular structures with hyperechogenic walls and anechogenous lumen: the walls are usually even, the vessel is difficult to compress when the sensor is pressed. Jugular veins are located lateral to the carotid arteries and are compressed easily. The veins differ considerably in diameter during the respiratory cycle and during the Valsalva test.

Thyroid. The thyroid gland consists of two lobes located on both sides of the trachea, connected by a mediocre line through the isthmus. Both lobes and isthmus have the same, homogeneous ehostruktura, while the shares are approximately equal in size. On the cross sections, the shares have a triangular shape; on longitudinal - 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. Study of the sternocleidomastoid muscle is extremely important in children. The muscle is represented by a ribbon-like structure, less echogenic than the tissue of the thyroid gland. With a transverse scan, the muscle contour is determined very well, but the shape of the cut varies from round to oval.

The lymph nodes. Normal lymph nodes can be visualized as hypoechoic structures with a diameter of less than 1 cm.

Pathology of the thyroid gland

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

Focal changes

1. Solid. About 70% of focal changes are represented by nodes of the thyroid gland. About 90% of the nodes are adenomas, which are very rarely malignant. The echographic pattern of adenomas varies considerably, and it is impossible to differentiate a benign thyroid adenoma and a malignant tumor: their echostructure can be the same. Diameter of formations is not a differential diagnostic feature. Both benign and malignant tumors can be hypo- and hyperechoic; both can have a cystic component. Nevertheless, if the tumor has a clear contour and a thin anechogenous rim, there is a 95% chance of having a benign adenoma. In the presence of central necrosis, there is a possibility of a malignant process.
2. Cysts. True cysts of the thyroid gland are rare. Usually they have an even and clear contour, an anechoic cavity, except in cases when a hemorrhage occurs in the cyst cavity.
3. A hemorrhage or abscess in the thyroid gland is found and appears in the form of a cystic or mixed echogenous structure with a fuzzy outline.
4. Calcification. When the echography reveals hyperechoic areas with a distal acoustic shade. The most common calcification is diagnosed with thyroid adenomas, but can also occur with malignant tumors. Calcinates can be single and multiple, arranged by chains or groups. It must be remembered that the size of the node, as well as the presence or absence of calcinates, are not differential-diagnostic signs of malignancy or benignness of the process (X-ray examination also does not provide additional information).

An enlarged thyroid gland with internal calcification may or may not have a malignant process. Neither sonography nor x-ray does not determine the malignancy or goodness of the tumor.

[1]

Diffuse changes in the thyroid gland

An enlargement of the thyroid gland with a uniform echostructure

The thyroid gland can be enlarged, sometimes spreading backward. The increase may affect only part of the share, the entire share, isthmus, or both lobes. The enlargement is more often caused by hyperplasia, while the echographic structure can be uniform. This may be endemic goiter caused by iodine deficiency, pubertal hyperplasia, thyrotoxicosis, or vicarious hyperplasia after resection of the thyroid gland. A small, uniform, reduced echogenicity of the gland can be observed with acute thyroiditis.

Thyroid gland enlargement with heterogeneous echostructure

If the enlargement of the thyroid gland is accompanied by the heterogeneity of the echostructure, this is usually due to multiple nodes (multinodular goiter); nodes can be solid or have a mixed echogenicity in echography. With autoimmune thyroiditis, the thyroid structure becomes non-uniform and can simulate a multinodular goiter.

[2], [3], [4], [5], [6], [7]

Other neck area educations

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

Abscesses

The size and shape of the neck abscesses vary considerably, the contour of abscesses is often fuzzy and uneven. With ultrasound, there is often an internal echostructure. In children, the abscess is most often localized in the retrofaringine space.

Lymphadenopathy

Diagnosis of enlarged cervical lymph nodes is usually performed by clinicians, but ultrasound is an excellent method of dynamic observation. When echography, the lymph nodes look like hypoechoic formations with distinct contours, single or multiple, oval or round, with different diameters larger than 1 cm. With the help of echography, the cause of enlarged lymph nodes can not be determined.

Cystic hygroma (neck lymphangioma)

They have different sizes, located in the lateral areas of the neck, can spread to the chest and axillary region. With ultrasound, they look like liquid-containing structures, often with septa.

Rarely encountered neck formations

In children, echogenic formation may be a hematoma. Among the cervical muscles with a cystic or mixed in the echogenicity of the structure may be a thyroid-lingual cyst (the middle cyst of the neck), a cyst from the elements of the embryonic gill slit (lateral cyst of the neck) or dermoid.

Vascular pathology

With the help of ultrasound it is possible to detect atherosclerotic plaques, stenosis of carotid arteries, however, blood flow can be determined only with Doppler study and in many cases with angiography.

Complete obstruction of the carotid artery can be diagnosed only with Doppler study

Ultrasonic scanning of the neck does not require special preparation, therefore it is considered one of the most convenient studies that can be carried out at any time. As a rule, the ultrasound is made by the surgeon and endocrinologist, as these specialists are engaged in the diagnosis and treatment of neck diseases.

In Kiev:

• Clinic "Ultrasound Pro" - st. Baggovutovskaya, 38, ph. [phone].
• The network of medical clinics "Viva" - ul. Lavrukhina, 6, tel. [phone].
• The diagnostic center "Omega Kiev" - Mayakovsky Avenue, 70, tel. [phone].
• Medical Center "Euroclinic" - st. Melnikova, 16, tel. [phone].
• Metropolitan Clinic (on the basis of the "Clinic Hippocrates") - st. Lepse, 4A, tel. [phone].

In Moscow:

• The network of multi-profile clinics "Your Health" - ul. Pererva, 52, tel. [phone].
• Presnensky Center of V.I. Dikul - st. 1905, 7, tel. [phone].
• Clinical and Diagnostic Center "Clinic of Health" - lane Klimentovsky, 6, tel. [phone].
• Medical Center "Patero Clinic" - Mira Avenue, 211, tel. [phone].
• MedFORD clinic - st. Aviamotornaya, 4/3, tel. [phone].

In St. Petersburg:

• Clinic "Doctor San" - st. Marata, 78, tel. [phone].
• Multidisciplinary medical center "Grange" - st. Marata, 25A, tel. [phone].
• North-West Endocrinology Center - ul. Savushkina, 124/1, tel. [phone].
• Multi-profile medical center "Exclusive" - st. Krasnoputilovskaya, 8, tel. [phone].
• Clinic of Doctor Vojta - st. Furshtatskaya, 18/20/25, tel. [phone].