86 year old female presents complaining of progressive dysphagia
and weight loss.
Papillary thyroid carcinoma.
CT examination of the neck demonstrates a heterogeneously
enhancing mass lesion that arises from the left lobe of the thyroid
gland. This mass appears to invade and distort the esophagus
towards the right, significantly compromising its lumen. This
lesion is also seen to be abutting the posterior and left lateral
borders of the trachea, causing minimal deformation. The mass
continues inferiorly for some distance into the superior
Biopsy revealed papillary carcinoma of the thyroid.
Papillary carcinoma of the thyroid accounts for 60% of all
thyroid carcinomas with a peak incidence in the fifth decade. There
is a female preponderance. Metastases are generally to regional
lymph nodes, although hematogenous spread does occur to the lung in
some instances. Survival is 90% at 10 years for those with occult /
intrathyroidal cancer. Survival at 10 years decreases to 60% with
extrathyroidal disease. Prognosis is worse for both groups given
CT imaging of the thyroid gland is useful in that it cannot only
provide additional information from other modalities, but it may
even detect some lesions missed by either ultrasound or
radionuclide imaging. Although there are no definite CT
characteristics of a thyroid lesion to indicate malignancy, there
are a few findings that may be suggestive. These include nodal
disease in the neck and aggressive behavior such as bone or
cartilage destruction. Interestingly, recurrent laryngeal nerve
palsy is also a strong indicator of malignancy as benign thyroid
disease rarely causes this problem.
1) Bergeron, Osborn and Som. Head and Neck Imaging. St Louis:
The C.V. Mosby Company, 1984.
2) Dahnert. Radiology Review Manual. Baltimore: Williams &