0:05

So, um, on this one, I think, what did you say on this one, Han?

0:08

Do you remember?

0:10

I just mentioned it is a tumor because to me,

0:13

my common brief will, whenever I see a CT scan, thyroid lesion,

0:18

I will characterize further with ultrasound.

0:21

I s make conclusion from the CT scan. Unless it, it's very,

0:25

you define like anaplastic. Other than that,

0:28

I usually don't comment on anything.

0:31

Yeah, I think that's,

0:33

I just from the, from your explanation,

0:35

I just remember there's a white paper sometimes I used to,

0:38

to comment on the size, is it more than one point,

0:41

1.5 or one C according to the age, but not all the time. I will report it.

0:47

You share, I,

0:49

I say other maybe out of 10 times I will report five times in the

0:53

impression for using the white paper.

0:57

I so use most of the time after this.

1:00

Okay. No, I think that's very reasonable, very reasonable approach.

1:04

Now I did give you my template for incidental thyroid nodules. Yeah. So I,

1:08

that that sort of came, yeah,

1:10

I came from the A C R I sort of have to rummage that up.

1:13

I kind of put it in there just to provide more evidence-based approach.

1:16

I don't want to tell, you know, referring physicians what to do.

1:20

But on the other hand, at least I can provide guidelines. Um, and this one,

1:24

you know, like I said, this is a pretty dominant mass.

1:27

So it really is concerning for a, for a, for a tumor. And you're right, I mean,

1:31

you don't necessarily have to put the type of tumor in your differential.

1:34

I just wanted to, to kind of, uh,

1:36

put it in there just to get a sense of if you knew what the differential was,

1:41

but I completely understand your logic and your, and your thinking.

1:48

I just have one question for this kind of tumor, the direct tumor,

1:53

usually they'll ask to look for any retro stern extension.

1:57

And I have difficulty whether is always I will see that

2:02

the,

2:02

the direct tumor to be extend to the behind the man instead of the sternum.

2:07

But I still call it retrosternal extension,

2:12

Right? Yeah, I think so. I think for really to go behi behind the sternum,

2:16

it's gotta go super, super low. So I think this is still too,

2:22

I still think this is a little too, um,

2:24

it's too high to really be called retrosternal extension.

2:27

Okay. Yeah.

2:29

Yeah. Let me see,

2:34

since it's just you and I and we have an hour, let me see if I can, um,

2:39

let me see if I can bring up, have you seen examples of thyroid that extend, uh,

2:43

into the sternum?

2:46

Uh, uh, quite often.

2:48

Usually they'll request a C C C CT neck and Doris to look for

2:52

retrosternal extension,

2:53

but I just don't know how long I will call it retro sternum extension.

2:58

Right, right, right. Um, lemme see if I can bring one up here.

3:03

So how about that?

3:06

Yeah, it's very low.

3:08

It's very low. So for me it has to go through, before I call it retrosternal,

3:12

it has to go below the acromioclavicular joint for me to call it, uh,

3:16

retrosternal extension. Yeah. So I think that, here's a good example here.

3:21

Now we're at the level of superior mediastinum.

3:23

They're the clavicles right here. Uh,

3:26

and there's another example here.

3:28

So this is an example of the acromioclavicular joint and you can see the, uh,

3:32

greater is extending below, and here it's truly retrosternal.

3:37

Does that help answer that question?

3:40

Yes. So it means that if below the acromial otin,

3:44

we'll call it retro.

3:46

Yeah, I believe that's right. Yeah. That's how I normally do it.

3:49

Mm-hmm. And do we need to comment on the airway, the trachea? Yes.

3:53

If it says osi, do we need to give the measurement? If we,

3:58

if we need to give measurement, is it AP or the reef?

4:01

Um, I have

4:02

Difficulty. Yeah.

4:04

Yeah. I don't give measurements on that.

4:06

I just say it's displaced or narrow because typically the patient's may present

4:09

with some strider.

4:11

Yeah.

4:12

So I think what all the clinicians wanna know is whether or not the ator is

4:16

actually compressing the trachea.

4:18

Okay. Just mention it's mild, moderate, severe.

4:21

We don't really need to give measurement.

4:24

Um, yeah, I would, yeah, it depends.

4:26

And so you have to be consistent with what you're, okay.

4:29

You have to be consistent with what you're gonna say. Is mild, moderate,

4:31

or severe?