Mummified thyroid nodule: a diagnostic and management conundrum

Value of Contrast-Enhanced Ultrasound in Mummified Thyroid Nodules

“…Previous studies have shown that the typical MTNs have US imaging features, such as solid components, marked hypoechogenicity, punctate echogenic foci, double black-and-white peripheral halos and posterior shadowing (9). Comparison with previous images showing thyroid nodule shrinkage over time is useful for reaching the correct final diagnosis (5,9,15). Thus, some patients with MTNs could effectively avoid any unnecessary FNA or even surgical procedures, which maybe cause more severe complications (16)(17)(18).…”

Diagnostic performance of ACR-TIRADS combined with superb microvascular imaging for differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas

“…Lacout et al referred to these as mummified TNs (MTNs) ( 8 ). According to ACR-TIRADS, MTNs should have at least two suspicious US features suggestive of malignancy, including a gently irregular margin, solid composition, hypoechoic echotexture, and punctate echogenic foci suggestive of microcalcifications ( 9 , 10 , 11 ). In patients with no definite medical history and no previous US examination results, these nodules are often classified as TIRADS score 4 or 5, and may be mistaken for malignancies, leading MTN patients to undergo unnecessary repeated FNA procedures, or even surgery ( 12 ).…”

“…It is difficult to distinguish these nodules from papillary thyroid carcinomas (PTCs) based solely on two-dimensional US features, and the diagnostic efficiency of conventional US for MTNs is limited. Previous studies showed that the vascular system in benign TNs was destroyed during mummification ( 11 ), while PTCs include abundant vasculature and branching vessels due to abnormal angiogenesis during carcinogenesis, as cancer cells invade nodule areas deficient in blood vessels ( 13 , 14 ). MTNs and PTCs thus have different distributions of branching vessels and microvascularization.…”