Neck ultrasonography and biopsy were key to the evaluation of children with suspected thyroid nodules. Although the relative cancer prevalence of sonographically confirmed nodules ≥ 1 cm is higher in pediatric patients than adults, most children referred for suspected nodules have benign conditions, and efforts to avoid unnecessary surgery in this majority are warranted.

arterial therapies. This study sought to assess the major complication rates associated with arterial and venous lytic therapies with the hypothesis that the complication rates may be higher with venous as compared to arterial treatments.Methods: This study is a single-center, retrospective review of arterial and venous lytic treatments that were performed between the dates of December 2010 and April 2015. Treatment areas included all arterial and venous beds; however, dialysis access and pulmonary embolism treatments were excluded from the analysis. Treatment protocols for lytic therapy were standardized, with modifications made according to attending discretion. During the pharmacomechanical thrombectomy portion, the appropriate AngioJet rheolytic catheter was used based on the target vessel diameter. A maximum of 10 mg of tPA was used at the index treatment. Lytic therapy was continued postoperatively at a rate of 1 mg/h. This was titrated postoperatively based on serial laboratory examinations of fibrinogen, CBC, PTT, and CPK (arterial cases). The tPA was titrated based on the fibrinogen level: fibrinogen 200-250 (tPA at 0.5 mg/h); fibrinogen <200 (tPA held); fibrinogen <100 or any sign of bleeding (tPA reversal). Access site and systemic complications were evaluated.Results: A total of 93 patients were included in the cohort (A-52 vs V-41). The gender breakdown (% women) did not differ significantly between the two cohorts (A-63% vs V-78%; P ¼ .17). The age did differ significantly between the two cohorts (A-68 years vs V-50 years; P < .01). There were 6 complications (11.5%) in the arterial lytic group, with one associated mortality, and 6 complications (14.6%) in the venous lytic group (P ¼ NS). There were no significant differences in the total number of complications, although the complication types trended towards an increase in systemic complications in the venous patients (P ¼ .2; Table ).Conclusions: This study suggests that the overall complication rates as related to venous lytic therapy are equivalent to those for arterial lytic therapy; however, the nature of the complications may differ, with a trend toward increased systemic complications in venous patients. This study provides for further impetus to evaluate venous lytic treatments as a separate entity from arterial lytic treatments, specifically with regards to indications for treatment, procedural technique and tPA dosing.

In a retrospective analysis of childhood thyroid nodules, 18% were radiographic incidentalomas and 41% were discovered by a clinician's palpation; 40% were discovered by patients' families. The latter group had the largest nodules and highest rates of thyroid cancer metastasis, suggesting opportunities for earlier detection through annual well-child visits.

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