Male, 61 years old, with newly diagnosed thyroid cancer. Evaluate extent of disease. A very large, heterogeneous mass is identified arising from the region of the right thyroid lobe measuring 87 mm (TV) by 75 mm (AP) by 83 mm (CC). In the CC dimension, this lesion extends from the level of the submandibular space down to the level of the manubrium. In the AP dimension, it extends from the anterior margins of the C5 through T1 vertebral bodies nearly to the skin surface. In the TV dimension, the lesion extends from the strap muscles and sternocleidomastoid to the level of the trachea with marked leftward deviation of the trachea. Despite the marked deviation of the airway, the airway does remain patent.The carotid and jugular vessels pass along the posterior lateral aspect of this tumor. The carotid artery seems to remain patent and, although it closely abuts the lesion, is not clearly engulfed by the lesion. The internal jugular vein is deviated and narrowed. There remains the appearance of a very thin fat plane between this lesion and the trachea itself. The tumor closely approaches the right aspect of the thyroid and cricoid cartilages but without definite evidence of invasion.A clustering of right level 2, 3 and 4 lymph nodes are seen along the margin of the tumor which, although not pathologically enlarged by size criteria, are suspicious by virtue of their number. No pathologic adenopathy is detected on the left side of the neck. The salivary glands are unremarkable. Marrow signal characteristics are within normal limits.
Very large tumor arising from the right thyroid bed compatible with the history of thyroid cancer.