Ultrasound neck at initial presentation
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The right lobe of thyroid measures 17mm x 37mm x 16mm. It appears to be mildly bulky and shows multiple superiorly and anteriorly located markedly hypoechoic lesions measuring from few millimeter to a maximum size of 8mm. Some of the focal lesion appears to be conglomerated.
Multiple similar appearing hypoechoic nodules also noted in the isthmus, largest of them measuring up to 9.9mm x 5.9mm. This nodule shows well defined margins, but appears to be conglomerated with adjacent located nodules. The left lobe of thyroid also shows three to four similar appearing hypoechoic nodules measuring only between 2mm to 4mm in size and showing well defined margins. Left lobe of thyroid is normal in size and measures approximately 13mm x 12mm x 27mm. The peripheral interface of thyroid gland appears to be maintained. There is evidence of at least one paratracheal lymph node on the left side measuring 6mm x 3mm showing fatty hila and oval shape.
Evidence of significant supraclavicular lymph node noted on the right side measuring up to 16mm x 11mm showing rounded shape, mildly hypoechoic and thickened texture with maintained vascularity and no evidence of neo angiogenesis. This lymph nodes shows well defined margins. Surrounding fat planes appear normal. No significant adenopathy was noted elsewhere in the jugular chain on either side in the region of level III, IV, V or VI.
Bilateral parotid glands are markedly enlarged and the right parotid gland measures up to 44mm x 18mm and the left parotid gland also shows similar sizes. The both parotid glands shows diffusely heterogeneous texture due to presence of multiple tiny hypoechoic nodules, some of them showing conglomeration. This nodule shows similar morphology as that of previously described thyroid nodules. The nodules appears to be solid in appearance as suggested by intralesional vascularity and unlikely to represent abscess or liquefication. No obvious dilated duct is noted. There is also evidence of one to two intraparotid lymph nodes on both side. A significant appearing retroparotid lymph node noted on the right side measuring up to 18mm x 7mm.