case_images: PMC11304353_01
case_images: (a) Transverse view ultrasound image of the thyroid gland shows a well-defined, isoechoic, oval nodule with a thin peripheral halo (orange arrows) in the left lobe. (b and c) Longitudinal view ultrasound. The lesion in the left lobe of the thyroid gland (b) demonstrates predominantly peripheral flow on colour flow Doppler (c).
case_images: SAJR-28-2863-g001.jpg
case_images: PMC11304353_01_SAJR-28-2863-g001.jpg
case_images: F0001
case_images: Ultrasound findings showed a 43 mm x 41 mm x 27 mm solid, isoechoic homogenous nodule with a thin peripheral halo (Figure 1a) and predominantly peripheral flow (Figure 1b and c), which was aspirated and diagnosed as a Bethesda IV category: consistent with a follicular neoplasm or suspicious for a follicular neoplasm.
case_images: (a) Hematoxylin and eosin (H&E) stained section of the encapsulated follicular adenoma (yellow arrows). (b) H&E section of the vascular lesion (yellow arrows) comprising large cystic, thin-walled, blood-filled spaces, containing organising thrombi (black triangles), separated by connective tissue with background thyroid tissue (blue crosses).
case_images: SAJR-28-2863-g002.jpg
case_images: PMC11304353_01_SAJR-28-2863-g002.jpg
case_images: F0002
case_images: On microscopic evaluation, a follicular adenoma was present with a mixed micro- and macrofollicular growth pattern, measuring 45 mm x 35 mm (Figure 2a). In addition, a vascular lesion measuring 5 mm x 8 mm was identified immediately superior to the follicular adenoma, comprising large cystic, thin-walled, blood-filled spaces, lined by flattened cells and separated by connective tissue (Figure 2b).
case_images: Colour flow Doppler ultrasound (longitudinal view). Focal area of increased flow (yellow arrows) superior and adjacent to the well-defined larger isoechoic nodule.
case_images: SAJR-28-2863-g003.jpg
case_images: PMC11304353_01_SAJR-28-2863-g003.jpg
case_images: F0003
case_images: A retrospective review of the US images identified a focal area of increased flow superior and adjacent to the well-defined larger isoechoic nodule (Figure 3), that correlated with the lesion identified on the histological specimen.