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Ectopic Lingual Thyroid on MRI: Diagnosis, Imaging Features, and Management

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Clinical Hook A 22-year-old woman presents with a persistent sensation of something being stuck in her throat. The symptom is nonspecific. A globus sensation can arise from gastroesophageal reflux, anxiety, pharyngeal irritation, muscular dysfunction, inflammatory disease, or a structural lesion. In a young patient, the initial clinical impression may therefore be reassuring. But MRI reveals something unexpected. At the midline tongue base, centered near the foramen cecum, there is a well-defined 12-mm mass whose imaging characteristics resemble thyroid tissue. A second 9-mm midline lesion is present more inferiorly. Most importantly, the thyroid gland is not identified in its expected cervical position. The apparent “mass” is not simply another head-and-neck lesion. It is ectopic thyroid tissue. This distinction matters because the lesion may represent the patient's only functioning thyroid tissue. Removing it without confirming the location and functional status of the normal thy...
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Partial Anomalous Pulmonary Venous Return With Sinus Venosus ASD: CT Diagnosis and Surgical Planning

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When Palpitations Are Not Just an Arrhythmia A man in his seventies presented with palpitations. At first glance, the clinical problem appeared straightforward. Palpitations in an older adult commonly lead to an electrocardiogram, ambulatory rhythm monitoring, and evaluation for ischemic or structural heart disease. But his chest radiograph contained a second message. The cardiac silhouette was enlarged, the main and central pulmonary arteries were prominent, and there was a suggestion of a small left pleural effusion. The combination raised a more important question: Why is the right side of the heart enlarged? That question changes the diagnostic pathway. The eventual CT examination demonstrated a complex but highly characteristic anatomy. The right upper pulmonary vein drained toward the superior vena cava, while the right middle pulmonary venous drainage also entered the right-sided circulation in association with a superior sinus venosus atrial septal defect. The right lower pulmo...
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