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Why a NODULE found in ULTRASOUND is not seen in MRI?

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Conflicting Results on Ultrasound and MRI.

Two months ago my doctor ordered a thyroid ultrasound. The ultrasound came back with evidence of a 2.7cm nodule. I was sent to an endocrinologist for a fine needle biopsy aspiration. When the doctor used the ultrasound, he noticed the same lump but described it as being behind the thyroid. He continued with the biopsy regardless. When he hit the growth, it was incredibly hard and virtually impenetrable. Additionally, it caused my left side to go numb and then radiate with pain.

The results came back inconclusive as he was unable to obtain a specimen. I was sent for an MRI which came back with no evidence of the growth found on the previous two ultrasounds.

I went to a head and neck surgeon for a second opinion. After reading the MRI findings, he said he couldn't see anything and that the Ultrasound tech might have read wrong.

He sent me away but I don't understand how two separate ultrasounds, one used to assist a FNBA could show something, and the MRI nothing. What was the biopsy of then? I want to let this go, but things just aren't adding up.


Thanks

Category: ENT Specialist

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Dr. Sunil Jalan
Category: ENT Specialist
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Expert:  Dr. Sunil Jalan
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Hello.



Thank you for using DoctorSpring.?com.?



?A ?2.7 cm size nodule is significant and? big enough to have been easily felt.

The ?head and neck surgeon c?ould have? definitely palpate?d?? a nodule? of this size? if ?it was ?present.? Since he did not find it, it is unlikely to be present.?

If it was present on two diff?erent? times, ?the ?only possibility ?is if it ?wa?s a cystic?(fluid filled)? lesion with shrinks?/?disappear?s?? following aspiration with FNAC, ?However? you ?have not mentioned about aspiration? of? fluid?. So? it is difficult to explain.



?What you should know is that ultrasound findings are operator dependent but MRI has no such limitations and is more reliable than ultrasound scans. Since MRI is normal, you need not worry.? If you are still apprehensive, you can visit a head and neck surgeon once again to get reassured.



Hope this helps. Feel free to ask if you have any further queries.



Thank you. 



Regards?,?

Dr. Sunil Jalan?,?

MBBS, DLO, MS(ENT), DNB, DAA?.



Patient replied :

Thank you for the clarity. As far as the the Aspiration - the endocrinologist was unable to obtain a specimen despite repeated efforts as the nodule was so hard. He described it as feeling calcified. His recommendation to was to wait 6 months and see if it increases in size. I sought the second opinion to confirm his recommendation - however, I was not expecting to hear that there was nothing present at all. As the nodule was located behind the thyroid, would that have made it more difficult for the doctor to feel? Thank you


Expert:  Dr. Sunil Jalan
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Hello.

Yes, it is difficult to palpate a node behind the thyroid. However, as it was more than 2 cm in size, it should have still been palpabale.

Since it is not present in the MRI, there might be some mistake, most likely in the ultrasound. So I suggest that you get a second opinion from local ENT or head and neck surgeon as they will be able to examine you again and can compare both USG and MRI films together. This will end all confusion.



Hope this helps.



Feel free to ask if you have any further queries.



Thank you.



Regards,

Dr. Sunil Jalan,

MBBS, DLO, MS(ENT), DNB, DAA.


Dr. Sunil Jalan
Category: ENT Specialist
Experience: 
DAA (Diploma in asthma and allergy) : Christian Medical College, Vellore, 2012
D.N.B (ENT), 2011
Residency - M.S. (Master post graduate degree in otorhinolaryngology),  Christian Medical College, Vellore, 2009
D.L.O. (Diploma in otorhinolaryngology) - Christian Medical College, Vellore, 2007
Medical School - M.B.B.S, S.P. Medical college, Bikaner, 2004
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