Case 1

ÁÖÁ¦ : °©»ó¼± ÃÊÀ½ÆÄ °Ë»ç Áß ¸¸³¯ ¼ö ÀÖ´Â ºñ°©»ó¼± Áúȯ
ÁÖ¼Ò : ¸ñ¿¡ µ¢¾î¸®°¡ ¸¸Á®Á®¼­ ³»¿øÇÑ 26¼¼ ³²ÀÚ. ¸¸Áö¸é ÅëÁõ°ú ¾ÐÅëÀÌ ´À²¸Áü.

Thyroid US

¼³¸í : Left lobe upper portion¿¡ hypoechogenic noduleÀÌ °üÂûµÊ.


Á¶¿µÁõ°­ Neck CT ¿µ»ó

¼³¸í : °©»ó¼± left lobe upper portion¿¡ °æ°è°¡ ºÒºÐ¸íÇÏ°í peripheral enhancement¸¦ º¸ÀÌ´Â low-attenuation lesionÀÌ ÀÖ°í º´º¯ÀÇ ³»ºÎ¿¡ air°¡ °üÂûµÊ. ÀÌ º´º¯Àº left pyriform sinus¿¡ ¿¬°áµÇ¾î ÀÖÀ½.


Esophagography ¿µ»ó

¼³¸í: left pyriform sinus¿¡¼­ °©»ó¼± ÂÊÀ¸·Î fistula°¡ °üÂûµÇ¸ç Á¶¿µÁ¦°¡ °í¿©ÀÖ´Â º´º¯ÀÌ ÀÖÀ½.


Áø´Ü¸í4th Branchial Cleft Anomaly with Infection
Review
Branchial cleft anomaly´Â Å»ý±âÀÇ embryonic branchial cleft°¡ Á¤»óÀûÀ¸·Î ¿ÏÀü Æó¼â°¡ ÀÌ·ç¾îÁöÁö ¾Ê°í ³²´Â °æ¿ì ¹ß»ýÇϴµ¥, cyst, fistula, sinusÀÇ ÇüÅ·Π³ªÅ¸³­´Ù. ÀÌÁß 4th branchial cleft anomaly´Â °©»ó¼±ÀÇ abscess ÇüÅ·ΠÁÖ·Î ³ªÅ¸³ª±â ¶§¹®¿¡ °©»ó¼± °áÀý·Î ¿ÀÀÎÇÒ ¼ö ÀÖ´Â º´º¯À¸·Î Àß ¾Ë·ÁÁ® ÀÖ´Ù.

ÁÖ·Î pharyngeal pouch¿Í ¿¬°áµÈ fistula ¶Ç´Â sinusÀÇ ÇüÅ·Π³ªÅ¸³ª±â ¶§¹®¿¡ esophagography¿¡¼­ pyriform sinus¿Í ¿¬°áµÇ¾î ÀÖ´Â fistula tractÀ» ¹ß°ßÇϸé Áø´Ü°¡´ÉÇÏ´Ù.

¼ºÀκ¸´Ù´Â ¼Ò¾Æ¿¡¼­ ´õ ÀÚÁÖ ¹ß°ßµÇ´Âµ¥ ¾à 93%¿¡¼­ ¿ÞÂÊ¿¡ ¹ß»ýÇϸç ÀÓ»óÀûÀ¸·Î ¹Ýº¹µÇ´Â °©»ó¼±ÀÇ Á¿± »óºÎ ¶Ç´Â ±× ÁÖº¯ÀÇ ÅëÁõÀ» µ¿¹ÝÇÑ ¸¸Á®Áö´Â º´º¯À¸·Î ³ªÅ¸³­´Ù. US³ª CTµîÀÇ ¿µ»ó¿¡¼­´Â °°Àº ºÎÀ§¿¡ abscess ¶Ç´Â focal thyroiditis·Î ³ªÅ¸³­´Ù.

Ä¡·á¹æ¹ýÀº ±Þ¼º ¿°ÁõÀÌ ÀÖ´Â °æ¿ì, ¿ì¼± ÀûÀýÇÑ Ç×»ýÁ¦¸¦ Åõ¿©Çϸç ÇÊ¿ä½Ã Àý°³ ¹× ¹è³ó¼úÀ» ½ÃÇàÇÏ¿© ±Þ¼º ¿°ÁõÀÌ ¿ÏÀüÈ÷ ¼Ò½ÇµÈ ÈÄ º´º¯ÀÇ ¿ÏÀü ÀûÃâ¼úÀ» ½ÃÇàÇÑ´Ù. ¶ÇÇÑ Pyriform sinusÂÊÀÇ °³±¸ºÎ¸¦ ·¹ÀÌÀú¸¦ ÀÌ¿ëÇÏ¿© ¼ÒÀÛÇÏ¿© Æó¼âÇÑ´Ù.



Case 2

ÁÖÁ¦ : °©»ó¼±ÀÇ diffuse microcalcificationÀ¸·Î ³ªÅ¸³¯ ¼ö ÀÖ´Â Áõ·Ê
ÁÖ¼Ò : 47¼¼ ¿©ÀÚ Lung cancer(adenocarcinoma) ȯÀÚ·Î staging work-upÀ» À§ÇØ ½ÃÇàÇÑ PET-CT¿¡¼­ °©»ó¼±ÀÇ hypermetabolic lesionÀÌ ¹ß°ßµÊ.

PET-CT

¼³¸í : LungÀÇ right lower lobe¿¡ lung cancer¿¡ ÇØ´çÇÏ´Â hypermetabolic lesionÀÌ ÀÖÀ¸¸ç thyroid gland left lobe¿¡µµ hypermetabolic lesionÀÌ °üÂûµÊ.


Thyroid US

¼³¸í : °©»ó¼±ÀÇ left lobe°¡ right lobe¿¡ ºñÇØ Á» ´õ Ä¿Á®ÀÖÀ¸¸ç ¾çÃø lobe¿¡ diffuse scattered microcalcificationÀÌ ÀÖÀ½.


Áø´Ü¸íMetastasis to the Thyroid gland from Lung Cancer
Review
<Diffuse microcalcification in thyroid gland>
°áÀýÀÇ ÇüÅ°¡ ¾øÀÌ °©»ó¼±ÀÇ diffuse microcalcificationÀ¸·Î ³ªÅ¸³ª´Â ÁúȯÀ¸·Î´Â diffuse sclerosing variant papillary thyroid carcinoma¿Í Hashimoto thyroiditis°¡ Àß ¾Ë·ÁÁ® ÀÖ´Ù. 2011³â Ann Surg Oncol.¿¡ ½Ç¸° Yoon JH µî¿¡ ÀÇÇϸé diffuse microcalcificationÀ¸·Î ³ªÅ¸³ª´Â case Áß 61.5% ¿¡¼­ papillary thyroid carcinoma¿´À¸¸ç ÀÌÁß 43.8%°¡ diffuse sclerosing variant PTC ¿´´Ù°í Çϸç, 38.5%´Â benign lesionÀ¸·Î ¸ðµÎ Hashimoto thyroiditis¿´´Ù°í ÇÏ¿´´Ù. ±×·¯³ª µå¹°°Ô thyroid gland·ÎÀÇ metastasis¿¡¼­µµ diffuse scattered microcalcificationÀÇ ÇüŸ¦ º¼ ¼ö ÀÖ´Ù.

<Metastasis to the thyroid gland>
°©»ó¼±À¸·ÎÀÇ metastasisÀÇ incidence´Â malignant thyroid tumor·Î thyroidectomy¸¦ ½ÃÇàÇÑ È¯ÀÚÀÇ 3-8.5% Á¤µµÀ̸ç, autopsy¸¦ ½ÃÇàÇÑ °æ¿ì 26%±îÁö º¸°íµÇ¾ú´Ù. °©»ó¼±À¸·ÎÀÇ ÀüÀÌ°¡ ÀÖ´Â °æ¿ì ¿¹ÈÄ°¡ ¸Å¿ì ÁÁÁö ¾Ê´Ù. Primary originÀ¸·Î´Â lung cancer°¡ °¡Àå ÈçÇϸç breast cancer, melanoma, renal cell carcinoma, stomach cancer ¼øÀ¸·Î ¾Ë·ÁÁ® ÀÖÀ¸¸ç, lung cancer Áß¿¡¼­µµ adenocarcinoma°¡ thyroid metastasis¸¦ ´õ ÈçÇÏ°Ô ÀÏÀ¸Å²´Ù.

¿µ»ó¼Ò°ßÀ¸·Î´Â 2015³â J Korean Thyroid Assoc. ¿¡ ½Ç¸° KH Leeµî¿¡ ÀÇÇÏ¸é °©»ó¼±À¸·ÎÀÇ metastasisÀÇ 57.8%´Â diffuse non-mass forming lesionÀ¸·Î ³ªÅ¸³ª¸ç ill-defined hypoechogenic infiltrative lesion (35.6%) ¶Ç´Â diffuse microcalcification (22.2%)ÀÇ US findingÀ» º¸Àδٰí ÇÏ¿´´Ù. ±× ¿Ü, solitary suspicious malignant nodule (31.1%), multiple suspicious malignant nodules (6.7%), non-suspicious thyroid nodule (4.4%)µî ´Ù¾çÇÑ ¾ç»óÀ¸·Î ³ªÅ¸³¯ ¼ö ÀÖ´Ù.

¼øõÇâ´ëÇб³ ºÎ¼Ó ¼­¿ïº´¿ø ¿µ»óÀÇÇаú ÀÓÇö°æ