Neck swelling

A 70-year-old male presented to the head and neck clinic with a history of a progressive midline lower neck swelling, which appeared suddenly, increased in size progressively and became prominent over 6 weeks. On examination, the swelling was about 5 × 2 cm in size, mobile and not adherent to the skin or underlying structures. The swelling was not prominent on tongue protuberance. Thyroid was impalpable, and the patient was clinically euthyroid with no evident Grave's disease features. It was neither associated with fever nor any other constitutional symptoms. His pressure symptom includes mild dysphagia to solids which compelled him to visit our hospital, but he did not encounter any respiratory complaint. The patient was not on any anticoagulants, but he was taking regular medications for diabetes and hypertension for many years.

 

Examination

Ultrasound neck showed a large well defined, thin-walled cystic neck lesion measuring about 5.1 × 2.6 cm (transverse x anteroposterior). There was no appreciable internal septation or solid tissue in it (Figure 1). No hypervascularity was noted within or periphery of the lesion. The internal content of the cyst was of 2 types; the basal part was homogenously low echogenic with a curved upper border, while the rest of the part was filled up with anechoic fluid. Few tiny echogenic foci were also seen in its low echogenic part, which did not give any comet tail artefact to be confidently called colloid content. The thyroid gland was not easily visible due to lateral push by this large cyst. The thyroid isthmus was hardly visible clearly. Lobes were found to be normal, but their echotexture was heterogeneous and micronodular with normal vascularity and intact echogenicity.