A thyroid cyst mimicking a large neck vein on ultrasound

Abstract

The use of ultrasound to aid placement of central venous catheters is routine practice in our institution. A 70-year-old female patient was admitted for elective cardio-oesophagectomy. Access to a large central vein is part of the anaesthetic procedure, and an ultrasound probe covered in a sterile sleeve was placed in the sternomastoid triangle. The scan revealed what appeared to be a large ‘compressible vein’(Fig. 3). The introducer needle was inserted into the ‘vein’ and to our surprise we aspirated straw-coloured fluid. On moving the probe further laterally we discovered another compressible shadow. This was the jugular vein. The surgeon who was standing by watching the procedure felt that the cyst was likely to originate from the thyroid gland. We now scan the jugular vein in two planes before needle puncture. A large structure resembling a vein seen on ultrasound imaging of the sternomastoid triangle.