Radiological Category:. Neuroradiology. Principal Modality (1): Principal Modality (2):. CT. Nuclear Scintigraphy. Case Report #0431. Submitted by:. Jin T. Kim, M.D. Faculty reviewer:. Clark W. Sitton, M.D. Date accepted:. 25 November 2007. Case History.
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Principal Modality (1):
Principal Modality (2):
Case Report #0431
Jin T. Kim, M.D.
Clark W. Sitton, M.D.
25 November 2007
6 year-old girl with dysphagia.
Non-contrast CT – Axial View
Non-contrast CT – Coronal View
Non-contrast CT – Sagittal View
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Findings and Differentials
The lesion is located in the midline or paramedian (usually on the left) between the thyroid gland and the hyoid bone. While thyroglossal duct cysts are more common than lingual thyroid glands, thyroglossal duct cysts are usually infrahyoidal. Thyroglossal duct cysts may also occur in the tongue base or floor of mouth.
A thyroglossal duct cyst will characteristically move with swallowing. The thyroglossal duct cyst usually does not appear as a simple cyst and sonographically appears as a cystic lesion with low-level intraluminal reflectors, presumably due to bleeding or infection.
Discussion – Thyroglossal Duct Cyst
Only the lingual thyroid tissue shows marked hyperdensity on the noncontrast enhanced CT scan due to its natural iodine content. The nuclear medicine study will demonstrate whether or not there is the presence of additional thyroid tissue. The nuclear medicine scan should clinch the diagnosis with the absence of thyroid tissue in the usual expected location.
The lesion usually manifests during young adulthood and adolescence because of thyroid enlargement, leading to dysphagia or airway obstruction. In 80% of cases the lingual thyroid tissue is the only functioning thyroid tissue in the body. Because thyroid hormone is vital for healthy growth as a child, the surgeon will often leave the lingual thyroid tissue in through adolescence, unless there is secondary airway obstruction. The presence of the ectopic thyroid does place the patient at risk (5% chance) of papillary cell carcinoma of the thyroid gland at the base of the tongue.
Discussion – Lingual Thyroid
From Larsen WJ. Human Embryology. 2nd Ed. New York:
Churchill Livingstone, 1997.
Discussion – Hemangioma
Discussion – Enlarged Lingual Tonsils