Photo Rounds
Large mass on base of tongue
Our patient’s tongue mass hadn’t bothered her until she became pregnant; that’s when it got larger and caused problems swallowing and breathing. A...
For years, I (MKC) have been teaching medical students and family medicine residents at my facility a modified anterior approach to examining the thyroid, and they are surprised at how much easier it is than the standard approach. Our modified anterior approach, which we demonstrate at https://www.youtube.com/watch?v=A6xVV8wiXZo, allows simultaneous visualization of both lobes and the isthmus of the thyroid gland. It differs from standard techniques because it involves simultaneously moving both sternocleidomastoid muscles farther apart, which causes the skin to be stretched over the thyroid gland, bringing it into relief and allowing for enhanced inspection and easier palpation.
A literature search that included PubMed and textbooks such as The Rational Clinical Examination: Evidence-Based Clinical Diagnosis1 and Bates’ Guide to the Physical Examination and History Taking2 suggests that this modified anterior approach hasn’t been described before. We believe this approach will correlate more closely with ultrasound examinations than currently used techniques, and we encourage readers to help us empirically test this assertion.
M. Kyu Chung, MD
Camden, NJ
Christina Chung Patrone, medical student
New York, NY
Patrick J. LaRiccia, MD, MSCE
Philadelphia, Pa