Ultrasonography.
2024 Mar;43(2):141-150. 10.14366/usg.23210.
Knot-and-ear sign: a pathognomonic ultrasonographic feature of suture granuloma after thyroid surgery
- Affiliations
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- 1Department of Radiology and Research institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- 2Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- 3Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- 4Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- 5Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- 6University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- KMID: 2552904
- DOI: http://doi.org/10.14366/usg.23210
Abstract
- Purpose
This study investigated the clinical and ultrasonographic (US) findings of suture granulomas and recurrent tumors, and aimed to identify specific characteristics of suture granulomas through an experimental study.
Methods
This retrospective study included 20 pathologically confirmed suture granulomas and 40 recurrent tumors between January 2010 and December 2020. The clinical findings included suture material, surgery, and initial TNM stage. The US findings included shape, size, margin, echogenicity, heterogeneity, vascularity, and internal echogenic foci. The distribution, paired appearance, and "knot-and-ear" appearance of internal echogenic foci were assessed. An experiment using pork meat investigated the US configuration of suture knots.
Results
Eighteen patients with 20 suture granulomas (15 women; mean age, 52±13 years) and 37 patients with 40 recurrent tumors (24 women; 54±18 years) were included. Patients with suture granulomas exhibited earlier initial T and N stages than those with recurrent tumors. The knot-and-ear appearance, defined as an echogenic dot accompanied by two adjacent echogenic dots or lines based on experimental findings, was observed in 50% of suture granulomas, but not in recurrent tumors (P<0.001). Central internal echogenic foci (68.8%, P=0.023) and paired appearance (75.0%, P<0.001) were more frequent in suture granulomas. During follow-up, 94.1% of suture granulomas shrunk.
Conclusion
The knot-and-ear appearance is a potential pathognomonic finding of suture granuloma, and central internal echogenic foci with paired appearance were typical US features. Clinically, suture granulomas showed early T and N stages and size reduction during follow-up. Understanding these features can prevent unnecessary biopsy or diagnostic surgery.
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