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24-Year-Old Male with Right Neck Swelling
This case features a 24-year-old male presenting with right neck swelling, ultimately diagnosed with papillary thyroid carcinoma.
Imaging overview:
Axial, coronal, and sagittal contrast-enhanced CT of the neck demonstrates cystic adenopathy at multiple nodal stations within the right neck, highlighted by the yellow arrows on the annotated images. The nodes contain enhancing soft tissue nodules and internal septa. The thyroid gland shows subtle low densities and heterogeneity without a sizable discrete primary lesion identified.
Clinical insight:
When cystic cervical adenopathy is encountered — particularly nodes containing enhancing soft tissue nodules, internal septa, or calcifications — metastatic papillary thyroid carcinoma should be high on the differential, even in younger patients. Importantly, the primary thyroid neoplasm may be occult on imaging, as demonstrated in this case. The absence of a clearly identifiable thyroid mass should not exclude the diagnosis, and clinical workup including ultrasound and fine needle aspiration remains critical for confirmation.
Case courtesy of Sean Brockman, MD and Benjamin Gray, MD, Indiana University School of Medicine.