Female, 80 years old, with left neck fullness and mass noted to be present for one year by patient. The left lobe of the thyroid gland is markedly enlarged and heterogeneous containing areas of enhancing and nonenhancing solid tissue as well as several locules of cystic material which may reflect proteinaceous fluid or hemorrhage. The right thyroid lobe is also heterogeneous but is only mildly enlarged. The left lobe measures approximately 8 cm x 5 cm x 9 cm and causes significant displacement of the adjacent structures including the airway which is deviated to the right but not compromised. The left carotid and jugular vessels are displaced laterally by the mass. The arterial flow void appears to be preserved. Patency of the jugular vein cannot be accurately assessed. The lesion extends superiorly to the level of the angle of the mandible, and inferiorly into the mediastinum. Apart from the significant lesional mass effect, there does not appear to be frank invasion of the adjacent or overlying soft tissue structures. No pathologic adenopathy is detected. Vertebral marrow signal remains within normal limits and there are no findings to suggest intraspinal invasion. Multilevel disc degeneration is seen with a retrolisthesis of C5 relative to C4 and C6.
The left thyroid lobe is markedly enlarged and very heterogeneous containing a mixture of enhancing and nonenhancing solid tissue as well as scattered cysts which may contain proteinaceous fluid or blood. The lesion exerts mass effect on the adjacent structures including the airway and the left cervical vessels. The differential diagnosis would include thyroid goiter as well as thyroid malignancy.