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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleHead & Neck

Zuckerkandl Tubercle of the Thyroid: A Common Imaging Finding That May Mimic Pathology

T.C. Lee, S.K. Selvarajan, H. Curtin and S. Mukundan
American Journal of Neuroradiology June 2012, 33 (6) 1134-1138; DOI: https://doi.org/10.3174/ajnr.A2914
T.C. Lee
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S.K. Selvarajan
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H. Curtin
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S. Mukundan
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  • Fig 1.
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    Fig 1.

    Drawings of 2 different thyroid glands as seen from a posterior point of view, with their relationships to the thyroid cartilage and a cut portion of the esophagus. The arrows indicate ZT and black dots indicate parathyroid glands.

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    Fig 2.

    Axial schematic representation of the thyroid (T = trachea, E = esophagus, black dot represents the right recurrent laryngeal nerve). A, Thyroid without apparent ZT. B, Thyroid with apparent right ZT. C, Thyroid with nodular right ZT (CCA = right common carotid artery within a lateral indentation of the thyroid contour).

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    Fig 3.

    Axial CT scan images demonstrate 3 different appearances of the ZT (arrows).

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    Fig 4.

    Patient A, with known ovarian carcinoma recurrence in the abdomen, presented with a few weeks' history of voice hoarseness and was noted to have a nodular area posterior to the right thyroid lobe. There was clinical concern for a metastasis or exophytic thyroid nodule.

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    Fig 5.

    CT-guided biopsy of Patient A in 2010 with questionable thyroid lesion (A) was performed because a recent sonography-guided fine-needle aspiration was read as indeterminate by pathology and there was persistent clinical concern despite stability from a CT in 2006. The patient was placed on the CT table with neck extended, and a metallic grid marker was placed on the section, showing the epicenter of the questionable lesion. B, A metallic grid marker is in place for biopsy planning. There is shoulder streak artifact through the questionable lesion, which lowers the attenuation. C, CT-guided percutaneous core biopsy needle was placed in the epicenter. Pathology results were consistent with normal thyroid tissue, with no malignant cells.

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    Fig 6.

    Patient A's pulmonary embolism chest CT from 2006 shows similar appearance of the questionable thyroid lesion.

  • Fig 7.
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    Fig 7.

    Patient B has similar appearance of the right thyroid lobe on a CT from December 2009, with a posterior extension on the right.

  • Fig 8.
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    Fig 8.

    Patient B's thyroid appeared similar as far back as 2005, allowing for slight difference in the obliquity of the axial section.

  • Fig 9.
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    Fig 9.

    A, Thyroid gland with a nodular ZT at the posterior aspect of the right lobe (arrow). B, Follow-up CT study demonstrating development of a discrete hypoattenuated nodule in the right lobe and a hypoattenuated nodule in the previously identified ZT (arrow).

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    Fig 10.

    A and B, CT images on a patient status post total thyroidectomy for thyroid cancer show a small enhancing lesion near the right tracheoesophageal groove (arrows), which likely represents a tubercle of Zuckerhandl. C and E, Axial and coronal CT demonstrates enlargement of a paratracheal lesion after an interval of 6 months (arrows in C and E); a nearby lymph node also showed enlargement (arrow in D) and proved to be recurrent disease.

Tables

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  • Number of CTs with demographic profile and distribution of ZT in our review

    n
    CT studies included96
    Patients with ZT67
    Mean age (years)56.1
    Males45
    Females31
    Right60 (89%)
    Left49 (73%)
    Percentage of patients with nodular appearance of ZT42.1%
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American Journal of Neuroradiology: 33 (6)
American Journal of Neuroradiology
Vol. 33, Issue 6
1 Jun 2012
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Cite this article
T.C. Lee, S.K. Selvarajan, H. Curtin, S. Mukundan
Zuckerkandl Tubercle of the Thyroid: A Common Imaging Finding That May Mimic Pathology
American Journal of Neuroradiology Jun 2012, 33 (6) 1134-1138; DOI: 10.3174/ajnr.A2914

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Zuckerkandl Tubercle of the Thyroid: A Common Imaging Finding That May Mimic Pathology
T.C. Lee, S.K. Selvarajan, H. Curtin, S. Mukundan
American Journal of Neuroradiology Jun 2012, 33 (6) 1134-1138; DOI: 10.3174/ajnr.A2914
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