Thyroglossal duct cysts: sonographic appearances in adults

Area of Science:

• Radiology
• Head and Neck Surgery
• Medical Imaging

Background:

• Previous literature suggested thyroglossal duct cysts (TDCs) consistently appear as well-defined cystic masses with thin walls and posterior enhancement on sonograms.
• This study challenges that notion, highlighting the variable sonographic presentation of TDCs based on clinical experience.

Purpose of the Study:

• To document the variability of sonographic patterns observed in thyroglossal duct cysts (TDCs).
• To characterize the diverse sonographic features of TDCs in a cohort of adult patients.

Main Methods:

• Retrospective review of sonograms from 40 patients with clinically diagnosed thyroglossal duct cysts (TDCs).
• Evaluation of sonographic features including location, internal echogenicity, posterior enhancement, septa, solid components, and fistulous tracts.
• Diagnosis of TDC was confirmed clinically by at least two head and neck surgeons.

Main Results:

• Four distinct sonographic patterns were identified: anechoic (28%), homogeneously hypoechoic with internal debris (18%), pseudosolid (28%), and heterogeneous (28%).
• The majority of TDCs exhibited posterior enhancement (88%), were located midline (63%), and infrahyoid (83%).
• A typical thin wall was observed in only half of the TDCs.

Conclusions:

• Thyroglossal duct cysts (TDCs) in adults demonstrate a complex sonographic appearance, deviating from the previously suggested simple cystic presentation.
• The findings underscore the importance of recognizing the spectrum of sonographic patterns for accurate TDC diagnosis.