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Large Colloid Cystic Nodule of Thyroid: Ultrasound Findings

Ultrasound Findings:

Anechoic or fluid-filled cystic center: This appears black on the ultrasound image.

Peripheral hyperechoic rim: The surrounding thyroid tissue is brighter than the cyst.

Lobulated margins: The edges of the cyst are irregular or bumpy.

Abundant freely floating echogenic foci: These are seen as bright dots or streaks within the cyst, likely representing colloid material. These may produce characteristic comet-tail artifacts due to acoustic shadowing.

Multinodular goiter: Presence of multiple nodules within the thyroid gland.

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Differential Diagnoses:

Follicular thyroid carcinoma: Requires further evaluation if the nodule demonstrates:

Microcalcifications (tiny bright flecks) within the cyst

Increased vascularity on Doppler ultrasound

Hemorrhagic thyroid cyst: May appear similar but with internal echoes due to blood products within the cyst.

Branchial cleft cyst: Less common, but may appear cystic in the neck and require differentiation.

Prognosis:

Large colloid cystic nodules with the described features are typically benign.

Risk of malignancy is low, but follow-up is recommended.

Management:

Reassurance and monitoring: Most cases can be managed with observation using serial ultrasound exams to monitor for any changes in size or characteristics.

Fine-needle aspiration (FNA): If features raise suspicion for malignancy, a biopsy with FNA may be recommended for definitive diagnosis.

Surgery: In rare cases, if the cyst causes significant cosmetic concern, compressive symptoms, or indeterminate cytology on FNA, surgical removal may be considered.

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