总结Riedel甲状腺炎的超声表现及病理特征。

回顾性分析1985年1月至2019年12月北京协和医院经手术病理或穿刺病理证实为Riedel甲状腺炎并有完整超声记录的患者共13例。分析其超声声像图表现及病理特征。

13例患者中，女性11例，男性2例，平均年龄（48.5±11.5）岁。病程2个月~10年。9例患者症状为发现颈部肿物。8例气管相显示气管受压。13例病变最大径范围1.1~6.0 cm，平均（3.9±1.3）cm。13例患者病变5例位于左叶，3例位于右叶，1例位于左叶及峡部，4例位于左叶、右叶及峡部。13例病变中9例形态规则，13例均表现为边界欠清的低回声，其中3例伴有中高回声，3例伴有无回声。1例颈总动脉周围可见低回声区。彩色多普勒血流成像显示9例病变为乏血供。13例病例均不伴有肿大淋巴结。12例患者进行了手术，术中可见甲状腺肿物，质硬。9例病变与周围肌肉、气管、食管、甲状软骨、颈动脉鞘粘连明显、固定。大体病理显示切面灰白、灰粉、实性质韧或硬，其中3例伴有不同程度中心部分出血、囊性变。镜下可见甲状腺组织广泛纤维化，实质萎缩，炎症及纤维化延伸至甲状腺周围组织。

Riedel甲状腺炎超声声像图有一定特征性，多表现为形态规则、边界欠清的低回声肿物，不伴有颈部异常肿大淋巴结。粗针穿刺组织活检或手术病理可明确诊断。

To investigate the ultrasonographic features and histopathological characteristics of Riedel's thyroiditis.

From January 1985 to December 2019, 13 patients were diagnosed as having histopathologically confirmed Riedel's thyroiditis and had detailed ultrasound records at Peking Union Medical College Hospital (PUMCH). The sonographic, histopathological, and clinical features of Riedel's thyroiditis in these patients were retrospectively reviewed.

The patients included eleven males and two females with a mean age of (48.5±11.5) years. The disease course was from 2 months to 10 years. The most common complaint was the discovery of neck masses (9/13). X-ray showed tracheal compression in eight cases. The maximum diameter of the lesion was 1.1 cm~6.0 cm [mean (3.9±1.3) cm]. Five lesions were located in the left lobe of thyroid, three were in the right lobe, one was in the left lobe and the isthmas, and four were in both the left and right lobes and isthmas. Nine of the lesions were regular in shape. All the 13 lesions were hypoechoic and ill-defined, of which three had hyperechoic parts and three had cystic changes in the lesions. In one case, a hypoechoic area was seen around the common carotid artery. Color Doppler blood flow imaging demonstrated hypovascularity in nine cases. Cervical lymphadenopathy was not present in all the 13 patients. 12 patients underwent surgery. During surgery, it was found that the thyroid lesions were hard (stony to woody). Compression of the trachea and extension of fibrosis into the adjacent strap muscles and surrounding carotid sheath structures were noted in nine cases. On histopathological examination, the lesions were pale-white or pink-white colored, tough or hard solid lesions, of which three were accompanied by different degrees of central bleeding or cystic changes. The inflammatory and fibrotic changes in the thyroid extended into surrounding tissue.

Riedel's thyroiditis is a rare disease with some ultrasonic features, and most cases present as hypovascular hypoechoic lesions with a regular morphology and ill-defined borders without cervical lymphadenopathy. The diagnosis can be confirmed by core-biopsy or surgical biopsy.