Presentation
Neck swelling on left side of the neck.
Patient Data
Left neck cystic mass lesion with peripheral soft tissue component which shows internal vascularity.
Few adjacent lymph nodes are noted.
Multiple thyroid solid nodules with an ill-defined one seen in the left lobe.
Large well defined cystic lesion with vascular soft tissue component is seen anterior to the left carotid vessels causing mass effect on the left internal jugular, the lesion measures 52 mm x 40 mm x 20 mm. No similar lesions seen.
Thyroid gland shows multiple nodules as described in USS report.
Few reactive lymph nodes are seen bilaterally in upper cervical and submandibular region.
Normal bilateral submandibular and parotid glands.
Normal parapharyngeal and retropharyngeal spaces.
Upper chest is unremarkable.
Normal opacification of the carotid space vessels.
Impression:
The presence of cystic lesion in the neck with associated thyroid nodules makes metastasis from papillary thyroid carcinoma the most likely possibility.
Lesion confirmed to be metastatic from papillary thyroid carcinoma.
Case Discussion
The presence of a cystic lesion in the neck with associated thyroid nodules makes metastasis from papillary thyroid carcinoma highly suspicious by imaging.
Careful search of primaries like squamous cell carcinoma and papillary thyroid carcinoma must be done when a cystic lesion is found in the neck.
Multiple cystic neck lesions are seen in:
- metastatic squamous cell carcinoma: older patient, M>F
- metastatic papillary thyroid carcinoma: usually a younger patient, F>M
- tuberculosis: demographic will depend on country and will reflect migration history
- treated lymphoma
- suppurative nodes: bacterial - usually has prominent surrounding fat stranding
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