J Korean Soc Radiol.  2012 Jun;66(6):507-517. 10.3348/jksr.2012.66.6.507.

Ultrasonographic Findings of Foreign-Body Granulomas after Endoscopic Thyroidectomy via an Axillo-Breast Approach

• Kim HR
• Hong HS
• Lee EH
• Lee MH
• Park JM
• Kwak JJ
• Lee SW

• KMID: 1439467
• DOI: http://doi.org/10.3348/jksr.2012.66.6.507

Abstract

PURPOSE
To assess the ultrasonographic (US) findings of foreign body granulomas detected by endoscopic thyroidectomy.
MATERIALS AND METHODS
On positron emission tomography-computed tomography of patients who had undergone endoscopic thyroidectomy, we encountered three fluorodeoxyglucose uptaken lesions in the surgical bed and those were pathologically confirmed to be foreign body granulomas. Additionally, 10 lesions demonstrating the same US findings were clinically diagnosed as foreign body granulomas. Echogenicity, shape, size, location, and vascularity were evaluated on US. Eleven lesions were subjected to follow-up US.
RESULTS
On US, seven lesions were found to be hyperechoic linear lesions with posterior acoustic shadowing while six other lesions were oval, iso- to slightly hypoechoic lesions. No vascularity was observed on color Doppler US. The size of the lesions was inversely correlated with the time to lesion detection (Spearman's correlation r = -0.6528; p = 0.02). Oval iso- to slightly hypoechoic lesions (mean, 672 days) had statistically longer times from the time of thyroidectomy to lesion detection on US than hyperechoic linear lesions (mean, 318 days; Mann-Whitney test, p = 0.02). On follow-up US, the lesions had decreased in size and hyperechoic linear lesions became oval iso- to slightly hypoechoic lesions.
CONCLUSION
In patients who underwent endoscopic thyroidectomy, characteristic US findings and evolutional changes are helpful for the diagnosis of foreign body granulomas and to distinguish from recurrent thyroid cancer, thus avoiding invasive procedures.

MeSH Terms

Acoustics
Electrons
Follow-Up Studies
Granuloma, Foreign-Body
Humans
Neoplasm Seeding
Shadowing (Histology)
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy

Figure

• 

  Fig. 1 A 38-year-old woman with biopsy-proven foreign body granuloma. A. A total of 311 days after thyroidectomy, US shows curved hyperechoic line with posterior acoustic shadowing (arrowheads) in the superficial layer of the left anterior chest wall, adjacent to the pectoralis major muscle. The lesion resembles a calcification on US but CT scan and pathologic examination show no calcification. B. Follow-up US after 476 days shows an oval, well-defined soft tissue echogenic lesion (arrowheads), isoechoic relative to the adjacent muscle. Color Doppler shows no vascularity. C, D. PET-CT scan, 442 days after thyroidectomy shows a well-defined nodule (arrowheads in C), slightly hyperdense compared to the muscle with increased FDG uptake (peak SUV = 2.3) (arrowheads in D). E. Microscopic findings show empty spaces with remnant amorphous material and adjacent fibrosis and foreign body giant cells (hematoxylin and eosin stain, × 40). Note.-FDG = fluorodeoxyglucose, PET-CT = positron emission tomography-computed tomography, SUV = standardized uptake value, US = ultrasonography

• 

  Fig. 2 A 55-year-old woman with biopsy-proven foreign body granuloma. A. A total of 762 days after thyroidectomy, US shows an oval, well-defined solid echogenic lesion (arrowheads), isoechoic relative to the muscle in the left chest wall. B. Color Doppler shows no vascularity (arrowheads). On follow-up US, the lesion disappeared (not shown). C. Enhanced CT scan, 711 days after thyroidectomy shows well-defined enhancing nodule (arrowheads), slightly hyperdense compared to the muscle. D. PET-CT scan, 711 days after thyroidectomy shows increased FDG uptake (p-SUV = 6.0) (arrow). E. Sections show deposition of amorphous eosinophilic material, infiltration of chronic inflammatory cells, and foreign body-type giant cells. Right side reveals dense fibrosis and rare empty spaces with amorphous material (hematoxylin and eosin stain, × 40). Note.-FDG = fluorodeoxyglucose, PET-CT = positron emission tomography-computed tomography, SUV = standardized uptake value, US = ultrasonography

• 

  Fig. 3 A 29-year-old man with foreign body granuloma. A. A total of 352 days after thyroidectomy, US shows straight hyperechoic line with posterior acoustic shadowing at the inner aspect of the left sternocleidomastoid muscle. B. Follow-up US, after 494 days, shows an oval isoechoic mass without posterior acoustic shadowing. Color Doppler US shows no vascularity. C. Enhanced CT scan, 413 days after thyroidectomy shows an oval well-defined enhancing nodule (arrow), slightly hyperdense compared to the muscle. Note.-US = ultrasonography

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