Ultrasonography of The Neck: O. Taeymans, DVM, Dip ECVDI

Ultrasonography of the
neck
O. Taeymans, DVM, Dip ECVDI
Department of Medical Imaging

Faculty of Veterinary Medicine
Ghent University
Belgium
1. The Thyroid
Anatomy
(Evans and Christensen, 1979)

Anatomy
(Evans and Christensen, 1979)

Approach
Wisner E., et al., 1994

(Wisner et al., 2002)
longitudinal
transverse
A. The dog
Introduction
thyroiditis
(50%)
primary
(95%)
Hypothyroidism idiopathic atrophy
(50%)
secondary
(5%)
non-functional (90%)
Neoplasia
functional (10%)
Neoplasia
• 1 - 4% of all canine neoplasia
• Middle to old age
• No sex predilection
• Boxer, Beagle, Golden
• +/- 90% = carcinomas
• 90% non-functional
• 10% functional  hyperthyroidism
• If extreme destruction of the gland  hypo
Neoplasia
• Usually unilateral
• Hypoechoic and heterogeneous
• Extensive vascularization
• Large, rapidly growing
• Locally invasive (esophagus, trachea, blood
vessels, muscles, nerves)
• Metastasizes easily to lungs
• > regional lymph nodes
Neoplasia
• Golden Retriever, 12 years, Carcinoma
Always check for mets...
+/- 30% have mets when presented...

Four months later....
• Border Collie, 8 years, Adenoma
Hypothyroidism
• Middle-aged dogs
• Mid- to large-size breeds
• Dobermann, Golden, Irish Setter,
Schnauzer, Airedale Terrier
• No sex predilection
• Intact females > spayed females
Hypothyroidism
Diagnosis of primary hypothyroidism can be a
challenge because ...
• Clinical signs are not specific and vague
• The tests are not 100% accurate
• Many factors can influence the results
Clinical signs
• Lethargy (20-76%)
• Dermatologic problems (60-80%)

Clinical signs
• Obesity (>40%)
Clinical signs
• Female infertility
• Neurological
• Cardiovascular
• Ophthalmologic
• Myxoedema
Hypothyroidism
• Clinical signs are not specific
Biochemical Tests
Test (%) TT4 TT3 FT4D TSH
Sensitivity 89-100 10 80-98 76-87
Specificity 75-82 92 93 82-93
Accuracy 85 55 95 84
(Peterson et al., 1997) (Dixon et al., 1999)

Hypothyroidism
A simple, ideal and reliable test is not
available
• TT4 is influenced by many factors (↓ for FT4)
• TSH stimulation test is not available
• Endogenous TSH: 1/3 hypothyroid dogs
have normal values
• => Routine: T4 (T or F) + TSH
Hypothyroidism
• Clinical signs are not specific
Factors influencing the thyroid
function
• Physiological factors
• Some drugs
• Systemic diseases
=> Lab tests alone → overdiagnosis

Physiological factors
• Age, breed, size

• Reproductive status
• Daily fluctuations
Drugs
• Dopamine, glucocorticoids,
lithium, sucralfate, estrogens,
danazol, phenobarbital, KBr,
furosemide, ß-blockers,
halothane, mitotane, NSAID’s,
sulfonamides, etc, ...
Systemic Diseases
• Cushing, CRF, neoplasia, liver

disease, cardiac disease
• Thyroid values ↓ ↓
• = “Euthyroid sick syndrome”

Hypothyroidism
Human medicine:
- biochemistry
- scintigraphy
- ultrasonography (US)
- US guided FNA or biopsy
(Barraclough and Barraclough, 2000)

Hypothyroidism
• US of canine thyroid → cervical mass
• US of canine hypothyroidism → ?
• Size ?
• Echo texture ?
Ultrasonographic Features of
the Thyroid Gland in 16
Hypothyroid Dogs
O.Taeymans, J.H. Saunders, S. Daminet
Department of Medical Imaging

Faculty of Veterinary Medicine
Ghent University
Belgium
Purpose
Assess the quantitative (size) and

qualitative (homogeneity and
echogenicity) US features of the
thyroid gland of hypothyroid dogs of
different breeds.
Materials and Methods
• 16 dogs with confirmed prim. hypothyroidism
(3 Beagles, 2 mix , 2 Schnauzers, 2 Dobermans, 2 Labradors, 1 Afghan,
1 Irish Setter, 1 Griffon, 1 Border Collie and 1 Bouvier)
• MBW = 31 kg / CMBW = 26 kg
• Multifreq. linear transducer set at 12 MHz
• No sedation, no anaesthesia
• Single observer
Materials and Methods
• Parameters: max. height, homogeneity
and the relative echogenicity compared to
the surrounding musculature.
• Height (= least variable parameter) was

compared to the mean height of thyroid
lobes of healthy Beagles (0.53cm) with
MBW = 13 kg.*
*(Taeymans O., et al., 2005)

Results
Mean Height:
• Healthy Beagles = 0.53 cm (13kg)
>
• Hypothyroid dogs = 0.47 cm (26kg)
=> Hypothyroid dogs tend to have

smaller glands
Results
14/16 (88%) dogs had abnormal glands
 25/32 lobes (78%) were hypoechoic

 24/32 lobes (75%) were heterogeneous
 15/32 lobes (47%) were both hypoechoic
and heterogeneous at same time
 4/32 lobes (12%) had a normal appearance
Bono, Border Collie, M, 3y.
Odine, Griffon, F, 6y.
• Brömel et al., JVIM August 2005
– 11 hypothyroid Golden Retrievers
– Hypoechoic and smaller
– Euthyroid sick syndrome: normal appearance
• Reese et al., JVIM August 2005

– 55 hypothyroid dogs of different breeds
– Hypoechoic and smaller
– US have a 98% sensitivity for hypothyroidism
– Euthyroid sick syndrome: normal appearance
Conclusion
Dogs with hypothyroidism have a strong
tendency for having small and/or
hypoechogenic and/or heterogeneous thyroid
lobes.
US may be a useful adjunctive test in the

diagnosis of hypothyroidism and to
differentiate hypo with euthyroid sick.
Follow-up: preliminary results...
Bono, Border Collie, M, 3y
T=0 T=1m
T=9m
Odine, Griffon, F, 6y.
T=0 T=2m
• 10/16 dogs came for re-check
• The following trend...
– After 2 months: further decrease in size
– After 8 months: increase in echogenicity
– Never normal glands again
B. The Cat
Hyperthyroidism
• Middle-aged to old
• No breed or sex predilection
• 99% Adenoma / 1% Carcinoma
• Functional
• 70% bilateral
• Smaller than carcinomas in dogs
• 4/6 have follow-up after 6 months
• Trends...
– Smaller
– Less vascularized
– If anechoic areas  diminish in size / disappear
2. The larynx
With the courtesy of H. Rudorf
Laryngeal neoplasm in a cat
With the courtesy of H. Rudorf

3. Salivary glands
Mandibular salivary gland
From Nyland & Mattoon

Parotid salivary gland
From Nyland & Mattoon

diseases of the salivary glands
• sialocele (cyst of the salivary gland)

• fistula
• foreign body
• stones in the salivary gland/ducts (sialoliths)
• inflammation of the glands (sialoadenitis)
• ectopia of the ductus parotidicus
• tumour
salivary cyst (mucocele)
With the courtesy of M. Kramer

cysts of the salivary glands
salivary fluid goes out of

the duct or the gland in
the surrounding soft
tissue

ultrasonography of sialoliths
• hyperechoic structures
• different size
• acoustic shadow
• movement
salivary gland cyst with sialoliths

4. Cervical abscesses
ultrasonography of cervical
abscesses
• age of the abscess
• unclear borders to the surrounding
tissue
• fluid with corpuscles
• movement
5. Foreign bodies
sonographic appearance of
foreign bodies
• hyperechoic
• smooth-rough
• sharp
• hypo- anechoic surrounding
• acoustic shadow
reverberation
side lobe artefact
6. Lymph nodes
ultrasonography of the
lymphnodes in the neck region
• hypoechoic
• homogeneous
• longish to oval
• near vessels
• hilus fat sign
Ln.
mandibularis

ultrasonography of enlarged
lymphnodes in the neck
• enlarged
• hypoechoic
• inhomogeneous
• round
• no hilus fat sign

Q ue
s tio
ns?

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Ultrasonography of the

O. Taeymans, DVM, Dip ECVDI

Department of Medical Imaging

(Evans and Christensen, 1979)

(Evans and Christensen, 1979)

Wisner E., et al., 1994

+/- 30% have mets when presented...

• Dermatologic problems (60-80%)

Sensitivity 89-100 10 80-98 76-87

Specificity 75-82 92 93 82-93

(Peterson et al., 1997) (Dixon et al., 1999)

=> Lab tests alone → overdiagnosis

• Age, breed, size

• Cushing, CRF, neoplasia, liver

• = “Euthyroid sick syndrome”

(Barraclough and Barraclough, 2000)

O.Taeymans, J.H. Saunders, S. Daminet

Department of Medical Imaging

Assess the quantitative (size) and

• Height (= least variable parameter) was

*(Taeymans O., et al., 2005)

=> Hypothyroid dogs tend to have

 25/32 lobes (78%) were hypoechoic

• Reese et al., JVIM August 2005

US may be a useful adjunctive test in the

With the courtesy of H. Rudorf

From Nyland & Mattoon

From Nyland & Mattoon

• sialocele (cyst of the salivary gland)

With the courtesy of M. Kramer

salivary fluid goes out of

With the courtesy of M. Kramer

With the courtesy of M. Kramer

With the courtesy of M. Kramer

With the courtesy of M. Kramer

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