Thyroid Ultrasound in Thyroid Tumor Ablation: Danger Triangle: US Lessons Learned in Master’s Class in Thyroid Ablation

Thyroid Ultrasound in Thyroid Tumor Ablation: Danger Triangle: US Lessons Learned in Master’s Class in Thyroid Ablation

Thyroid Ultrasound in Thyroid Tumor Ablation: Danger Triangle: US Lessons Learned in Master’s Class in Thyroid Ablation
Thyroid Ultrasound in Thyroid Tumor Ablation: Danger Triangle
Comments: Great review of the neck area to avoid dangerous structures.
US Lessons Learned in Master’s Class in Thyroid Ablation
The ability to sat clear of the danger triangle and the orther places nerves
are located and the ability of move structures away by the Hydrodissection technique of
dextrose infusions between the danger and the tumor before the ablation.
Dextrose does not conduct electricity and is safe to use.
One on One Master’s classes in thyroid tumor ablation by request.
Call Matt at 310-393-8860 or email [email protected] for details
of the 3-5 day course.
Richard Guttler MD,FACE,ECNU
Ultrasonography-Based Thyroidal and Perithyroidal
Anatomy and Its Clinical Significance
Korean J Radiol 2015;16(4):749-766
Eun Ju Ha, MD et al
For a safe and effective US-guided procedure, knowledge of neck anatomy, particularly that of the nerves, vessels, and other critical structures, is essential.
However, various procedure-related complications due
to the injuries of small neurovascular structures have
been reported (13-15). The establishment of US-based
anatomy, rather than cadaver-based, CT-based, or MRI-
based anatomy, is necessary to maximize the efficacy and
minimize the complications of US-guided procedures of the
neck.
Nervous System

1. The vagus nerve can be easily visualized on US as a 2-mm to 3-mm diameter structure.

It is typically located within the carotid sheath, and is usually posterolateral to
the common carotid artery (CCA) and posteromedial to the internal jugular vein (IJV).
dsc_0581
Fig. 1. Schematic drawing of transverse section of neck at C6 level.
Relationship of neck nerves to adjacent anatomic structures is shown.
1 = recurrent laryngeal nerve, 2 = vagus nerve, 3 = cervical sympathetic ganglion, 4 = cervical/brachial plexus, 5 = spinal accessory nerve, 6 =
phrenic nerve.dsc_0584
dsc_0586
Fig. 2. Ultrasonography (US) features and histologic correlation of neck nerve.
A.On transverse scan, nerve (arrowhead) is seen as honeycomb or reticular pattern with small, hypoechoic, rounded structures.
B.On longitudinal scan, it is seen as striated pattern with several parallel echogenic lines (arrowheads).
dsc_0589dsc_0587
Fig. 5. Relationship of recurrent laryngeal nerves to adjacent anatomic structures.
A.
Schematic drawing shows location of recurrent laryngeal nerve (arrows).
B.
Although recurrent laryngeal nerve is not directly visualized on
ultrasonography, its location can be expected in tracheoesophageal groove (arrows).
Fig. 5. Relationship of recurrent laryngeal nerves to adjacent anatomic structures.
A.
Schematic drawing shows location of recurrent laryngeal nerve (arrows).
B.
Although recurrent laryngeal nerve is not directly visualized on
ultrasonography, its location can be expected in tracheoesophageal groove (arrows).
A.img_0088
img_0085
Schematic drawing of cervical sympathetic ganglions.
Cervical sympathetic ganglions. Medial CSG (arrowheads) can be located both medially and laterally to common carotid artery,
img_0089
Horner syndrome was developed immediately after RF ablation in this patient. RF = radiofrequency
img_0095

RF Ablated area outside the nodule in danger triangle.

Vocal cord paralysis after radiofrequency ablation of left thyroid nodule.
Transverse ultrasonography
(A)
and CT
(B)
image show large ablated zone including tracheoesophageal groove (arrows).
C.
img_0098img_0096
Vocal cord paralysis
was confirmed on CT
img_0102 img_0100
Fig. 23. Hydrodissection technique.
A, B.
On transverse and longitudinal images, VN is located adjacent to metastatic tumor.
C.
5% dextrose solution is carefully injected between
nerve and tumor to prevent needle-induced thermal injury (arrowheads). M = mass, VN = vagus nerve
Add Your Comment

Contact Info
1328 16th Street, Santa Monica, CA 90404
Monday – Friday
9:00 AM to 5:00 PM
(310) 393-8860