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摘要:
目的 探讨灰阶超声和彩色多普勒超声在异位甲状腺诊断中的应用价值。 方法 回顾性分析北京协和医院1997年9月至2014年5月收治的13例异位甲状腺患者的临床资料及超声图像资料, 对照核医学检查、手术及病理结果, 分析其超声图像特征。 结果 13例中9例行异位甲状腺切除, 病理结果示单纯异位甲状腺3例(23.1%), 异位甲状腺乳头状癌1例(7.7%), 异位甲状腺合并甲亢治疗后改变1例(7.7%), 合并结节性甲状腺肿2例(15.4%), 合并结节性甲状腺肿伴淋巴细胞性甲状腺炎1例(7.7%), 合并结节性甲状腺肿伴纤维化、钙化及腺瘤样增生1例(7.7%)。超声声像图显示13例(100%)异位甲状腺均边界清晰; 12例(92.3%)为形态规则的圆形、类圆形或椭圆形, 1例(7.7%)形态欠规则; 6例(46.2%)呈混合回声, 3例(23.1%)呈中等回声, 4例(30.8%)呈低回声; 6例(46.2%)为囊实性, 7例(53.8%)为实性。彩色多普勒显示10例(76.9%)内部可见较丰富血流信号, 2例(15.4%)内部可见条状血流信号, 1例(7.7%)内部可见点状血流信号。 结论 异位甲状腺具有典型的超声成像特征, 可为临床决策提供有价值的诊断信息。 Abstract:Objective To investigate the diagnostic values of gray-scale ultrasound and color Doppler flow imaging for ectopic thyroid. Methods We reviewed the sonographic and clinical records of 13 patients with ectopic thyroid who were treated in Peking Union Medical College Hospital between September 1997 and May 2014, and analyzed the sonographic characteristics of the ectopic thyroid in comparison with nuclear medical, surgical, and pathological results. Results Nine of the 13 cases underwent ectopic thyroid excision, among which 3 (23.1%) were simple ectopic thyroids, 1 (7.7%) was ectopic thyroid with papillary thyroid carcinoma, 1 (7.7%) complicated with post-therapy changes due to radioiodine treatment for hyperthyroidism, 2 (15.4%) with nodular goiter, 1 (7.7%) with both nodular goiter and lymphocytic thyroiditis, and 1(7.7%) with nodular goiter accompanied by fibrillation, calcification and adenomatoid hyperplasia. In the ultrasonograms, all the 13 cases (100%) of ectopic thyroid displayed sharp borders, 12 cases (92.3%)manifested as regular round or oval shape, and 1 (7.7%) as irregular shape; 6 cases (46.2%) were mixed echoic, 3 (23.1%) were isoechoic, and 4 (30.8%) were hypoechoic; 6 cases (46.2%) were cystosolid masses, and 7 (53.8%) were solid. Color Doppler ultrasound showed rich blood flow in 10 cases (76.9%), strip-like blood flow in 2(15.4%), and spot-like blood flow in 1 (7.7%). Conclusion Typical ultrasound manifestations of ectopic thyroid can provide valuable diagnostic information for making appropriate clinical decisions. -
Key words:
- ectopic thyroid /
- ultrasound /
- diagnosis
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表 1 13例异位甲状腺患者的临床资料
病例 年龄
(岁)性别 正常部位有无
甲状腺临床表现 甲状腺显像 治疗 1 23 女 有 无症状 未检查 手术切除 2 42 女 无 无痛包块 考虑异位甲状腺 药物治疗 3 55 女 有 无痛包块 未检查 手术切除 4 36 女 有 渐大的包块伴疼痛、咽部异物感、憋气 考虑异位甲状腺 门诊随诊 5 16 女 无 无痛包块 考虑异位甲状腺 手术切除 6 73 女 有 腹痛伴食欲下降 未检查 手术切除 7 55 女 有 头晕 考虑胸骨后异位甲状腺 手术切除 8 60 女 有 阵发咳嗽、喘憋 未检查 手术切除 9 29 女 无 咽部异物感、进食梗阻感 考虑异位甲状腺 门诊随诊 10 14 女 有 包块伴眼突、多汗、手抖 考虑异位甲状腺功能自主性“热”结节 手术切除 11 57 女 有 全身骨痛、乏力 未检查 手术切除 12 51 女 有 肩臂痛 未检查 手术切除 13 32 女 有 无症状 考虑异位甲状腺 门诊随诊 表 2 13例异位甲状腺的超声特征及病理结果
病例 大小(cm3) 形态 边界 回声水平 内部结构 彩超 病理 1 1.1×0.7×0.5 椭圆形 清 中等回声 实性 血流丰富 异位甲状腺 2 1.8×1.5×1.2 椭圆形 清 混合回声 囊实性 血流丰富 无 3 2.4×2.0×1.6 椭圆形 清 低回声 实性 血流丰富 异位甲状腺 4 2.6×2.2×1.3 椭圆形 清 混合回声 囊实性 血流丰富 无 5 4.9×3.2×2.3 椭圆形 清 混合回声 囊实性 血流丰富 异位甲状腺合并结节性甲状腺肿 6 7.1×7.7×4.9 椭圆形 清 低回声 实性 血流丰富 异位甲状腺 7 4.3×5.8×3.0 椭圆形 清 混合回声 囊实性 少许条状血流 异位甲状腺合并甲亢治疗后改变 8 3.1×2.5×1.4 欠规则 清 混合回声 囊实性 血流丰富 异位甲状腺合并结节性甲状腺肿伴淋巴细胞性
甲状腺炎9 2.3×2.0×1.7 椭圆形 清 低回声 实性 少许点状血流信号 无 10 5.4×3.3×1.8 椭圆形 清 混合回声 囊实性 血流丰富 异位甲状腺合并结节性甲状腺肿 11 1.0×0.9×0.8 类圆形 清 混合回声 囊实性 血流丰富 无 12 1.8×1.5×1.2 椭圆形 清 低回声 实性 少许条状血流 异位甲状腺乳头状癌 12 3.1×2.3×1.2 椭圆形 清 中等回声 实性 血流丰富 异位甲状腺合并结节性甲状腺肿伴纤维化、钙
化及腺瘤样增生13 1.6×0.6×0.4 长椭圆形 清 中等回声 实性 血流丰富 无 -
[1] Felice MD, Lauro RD. Thyroid development and its disorders:genetic and molecular mechanisms[J]. Endocr Rev, 2004, 25:722-746. doi: 10.1210/er.2003-0028 [2] Yoon JS, Won KC, Cho IH, et al. Clinical characteristics of ectopic thyroid in Korea[J]. Thyroid, 2007, 17:1117-1121. doi: 10.1089/thy.2007.0004 [3] Ibrahim NA, Fadeyibi IO. Ectopic thyroid:etiology, pathology and management[J]. Hormones (Athens), 2011, 10:261-269. doi: 10.14310/horm.2002.1317 [4] Choi JY, Kim JH. Case of an ectopic thyroid gland at the lateral neck masquerading as a metastatic papillary thyroid carcinoma[J]. J Korean Med Sci, 2008, 23:548-550. doi: 10.3346/jkms.2008.23.3.548 [5] Comajuan SM, Ayerbe JL, Ferrer BR, et al. An intracardiac ectopic thyroid mass[J]. Eur J Echocardiogr, 2009, 10:704-706. doi: 10.1093/ejechocard/jep061 [6] Ozpolat B, Dogan OV, Gökaslan G, et al. Ectopic thyroid gland on the ascending aorta with a partial pericardial defect:report of a case[J]. Surg Today, 2007, 37:486-488. doi: 10.1007/s00595-006-3439-7 [7] Liang K, Liu JF, Wang YH, et al. Ectopic thyroid presenting as a gallbladder mass[J]. Ann R Coll Surg Engl, 2010, 92:W4-W6. [8] 郝强, 刘奉顺, 王小明.肾脏异位甲状腺1例[J].临床泌尿外科杂志, 2008, 23:683. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmnwkzz200809025 [9] 李如铨, 丁建涛, 顾霖.骶骨迷走甲状腺1例[J].骨关节软组织罕少疾病杂志, 2006, 13:60. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=hsjbzz200602031 [10] 李向东, 郑艳, 刘世喜.颈部异位甲状腺临床分析[J].中国耳鼻喉头颈外科, 2008, 7:389-390. [11] 牛丽娟, 郝玉芝, 周纯武.高频超声检查对颈部囊性病变的诊断价值[J].中华肿瘤杂志, 2006, 28:928-931. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhzl200612012