Goiter

*What is a goiter?*

A goiter is the name of the condition when the thyroid gland grows larger than normal. The thyroid is located at the base of the neck, just below the Adam's apple. The most common cause of a goiter is an iodine deficiency, but in the United States where we use iodized salt, it is more often due to the over or under production of thyroid hormones. It can also be caused from many other things including pregnancy, Graves Disease, thyroid cancer, and inflammation. 

*Symptoms*

Not all goiters will cause symptoms to appear. When symptoms do occur they may include visible swelling at the base of the neck, a tight feeling in the throat, coughing, hoarseness, difficulty swallowing, and difficulty breathing.

*Diagnosis*

A doctor may be able to notice a goiter simply be feeling the area of the thyroid while a person swallows. If he cannot feel it, he may order another test to be done. These can include a hormone test in which blood is drawn and tests are done to see if the hormones produced by the thyroid are high or low, an ultrasound of the thyroid, or a thyroid scan in which a radioactive isotope is injected to better visualize the thyroid. 

*Treatment*

Treatment of a goiter depends on its size. If it is not large and it is not causing any difficulties swallowing or breathing, observation may be best to make sure it doesn't grow larger. Medications can also be used to treat things such as hypothyroidism in which the thyroid overproduces a hormone, causing the goiter. Surgery can also be done to remove part or all of the thyroid if it causes difficulty breathing or swallowing. Another option for treatment is radioactive iodine which is taken orally and reaches the thyroid via the bloodstream. It destroys thyroid cells, diminishing the size of the goiter, but it can also cause an underactive thyroid gland.

This is an example of a goiter. 

This is a sagittal view of a person with a goiter. It is pointed out with the red arrow.

http://www.learningradiology.com/caseofweek/caseoftheweekpix2006/cow231arr.jpg

Arteriovenous Malformation

*What is Arteriovenous Malformation?*

Arteriovenous Malformations(AVMs) are defects of the circulatory system that are believed to arise during embryonic development or shortly after birth. The are comprised of tangled arteries and veins. The presence of an AVM disrupts the normal function of these arteries and veins, which is taking blood away from the heart and returning it to it. An AVM can develop in many different areas, but those in the brain and spinal cord can have widespread effects on the rest of the body. AVMs of the brain and spinal cord are believed to effect approximately 300,000 male and female Americans.

*Symptoms*

Most people with AVMs don't experience any symptoms and they are only detected during an autopsy or during treatment for an unrelated disorder. Symptoms only tend to occur when the damage from the AVM to the brain or spinal cord reaches a critical level. For those people that do experience symptoms, seizures and headaches are the most generalized. Other symptoms include muscle weakness or paralysis in one part of the body, a loss of coordination, dizziness, visual disturbances, and memory deficits just to name a few.  

*Diagnosis*

Angiography provides the most accurate pictures of blood vessel structures in an AVM. Contrast is injected into an artery and it highlights the blood vessels. CT and MRI can also be used to detect the presence of an AVM, as well as MRA and CTA which provides three dimensional representations. 

*Treatment*

Treatment is done on an individualized basis. Medication can be used to alleviate general pain that goes along with an AVM, such as back pain, headaches, or seizures. A few other options, if possible, are surgery or focused radiation therapy.

The first image is a CT scan showing a hemorrhage. The cause was unknown at the time, but after removal an AVM was found. The second image is the cerebral angiogram of the same patient done after the AVM was found in surgery. 

     

www.brain-aneurysm.com/avm.html

Nasal Polyps

*What are Nasal Polyps?*

Nasal polyps are teardrop-shaped growths on the lining of your nasal passages or sinuses. They are typically noncancerous. They are formed when the mucous membrane or your nasal passage and sinuses become chronically inflamed. Small polyps may go unnoticed, but larger polyps can block your nasal passage or sinuses and cause breathing difficulties, a loss of your sense of smell, and frequent sinus infections among other problems. They are seen more in adults, particularly those with asthma, frequent sinus infections, and allergies. Children with cystic fibrosis often develop nasal polyps as well. 

*Symptoms*

As mentioned earlier, small polyps will generally go unnoticed. On the other hand, if you have several polyps or large polyps you may experience a few different symptoms. Some of these are: runny nose, persistent stuffiness, postnasal drip, loss of sense of taste, decreased or no sense of smell, facial pain or headache, snoring, and itching around your eyes. As you may notice, some of these symptoms mimic the common cold, but if these symptoms last for more than 10 days you should see a doctor. 

*Diagnosis*

If you go see a doctor he may be able to tell by your answers to different questions about your symptoms, along with a general physical exam and examination of your nose if you have nasal polyps or not. Some polyps may be visible with a simple lighted instrument. If not, he may order a test for you to determine if you have polyps. These tests include a nasal endoscopy, which is a narrow tube with a magnifying glass or camera which is guided into your nasal cavity, a CT scan, or an allergy test to see if an allergic reaction is causing chronic inflammation. If a child presents with these symptoms, the doctor may prescribe a cystic fibrosis test. Cystic fibrosis affects the glands that produce mucus, tears, sweat, saliva, and digestive juices. 

*Treatment*

The goal in the treatment of polyps is to decrease the size of the polyps or to eliminate them and treat whatever is causing them to appear. Medications is one treatment a doctor may try. Nasal corticosteroids are often prescribed through a spray to decrease inflammation. It may also eliminate them completely. A doctor may also prescribe drugs to treat the conditions that are causing the chronic inflammation. If medication does not work , surgery may be required. There are two types of surgeries that are typically performed. One type is Polypectomy, which is where a small suction device is used to remove small polyps. Another surgery is Endoscopic sinus surgery, which removes the polyps and corrects problems with your sinuses that may be causing the polyps.

The image on the left is an Axial CT image and the image on the right is a Coronal CT image. They demonstrate nasal polyps shown by the arrows. 

http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/nasalpolyp3.html