Thyroid Ultrasonography and Fine Needle Aspiration Biopsy: A Practical Guide and Picture Atlas

Percutaneous Ethanol Injection

Author(s): Samer El-Kaissi and Jack R Wall

Pp: 85-87 (3)

DOI: 10.2174/9781681086859118010012

* (Excluding Mailing and Handling)

Abstract

Percutaneous ethanol injection post-fluid aspiration of pure thyroid cysts and predominantly cystic thyroid nodules is highly effective in preventing fluid reaccumulation. The procedure is simple, safe and is performed in the outpatient clinic under ultrasound guidance. A coordinated approach between the physician and an experienced assistant who controls fluid aspiration and alcohol injection is essential. Before ablation is undertaken, FNA biopsy of the solid component is essential to exclude malignancy. Any suspicious thyroid nodules should also be biopsied. Alcohol leakage is an uncommon but serious complication of percutaneous ethanol injection and may lead to voice changes due to demyelination of the recurrent laryngeal nerve. The trans-isthmic approach may be associated with a lower risk of ethanol leakage. Percutaneous ethanol injection is also effective for the ablation of metastatic cervical lymph nodes in thyroid cancer patients and may avoid the need for re-operation. However, ethanol ablation is not the first option in hyperfunctioning thyroid nodules and parathyroid adenomas due to poor response rates.


Keywords: cystic, thyroid nodule, percutaneous, ethanol, ablation, thyroid nodule volume, aspiration, two-way valve, trans-isthmic, ethanol leakage, nerve demyelination, proteinaceous, parathyroid adenoma, malignant cervical nodes, berry picking.

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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59825898 and j.to_ip >=59825898 )) and ((j.from_date <= 1740774256 and j.to_date >= 1740774256 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12821) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59825898 and j.to_ip >=59825898 )) and ((j.from_date <= 1740774256 and j.to_date >= 1740774256 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12821) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59825898 and j.to_ip >=59825898 )) and ((j.from_date <= 1740774256 and j.to_date >= 1740774256 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12821)
      2.88msalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 2636 and `b`.`banner_from_date` <= 1740774256 and `b`.`banner_to_date` >= 1740774256 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      11.28msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 2636
      • 3: 1740774256
      • 4: 1740774256
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='dbd40853380655cc1a0f7b1c6496ab15'
      350μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:291
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    15Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        1WulBh2r268AuVAGhFjwrlGQMMCvusHwtgOR8hBC
        uc_cart_id
        dbd40853380655cc1a0f7b1c6496ab15
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/12821" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/12821
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6ImdycGJNQXBMVDNFSHd2cXRqRklDc2c9PSIsInZhbHVlIjoicE9uQ2srK2tmMTVJRWMyMHdQbWcyZ2dNdmcrWjE2S0JyWVFGZDVWbmd2VT0iLCJtYWMiOiI4NjViOTYwZDdhNmQ3YzY4MWQ0NmUyMjE4NzFkMTNhZWVlMjA1ZDYxMzVjZTBmODMwNDBiOTU0ZThhOGY5OWJkIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6ImdycGJNQXBMVDNFSHd2cXRqRklDc2c9PSIsInZhbHVlIjoicE9uQ2srK2tmMTVJRWMyMHdQbWcyZ2dNdmcrWjE2S0JyWVFGZDVWbmd2VT0iLCJtYWMiOiI4NjViOTYwZDdhNmQ3" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Fri, 28 Feb 2025 20:24:16 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkhYMUdQMVcwbFJhSTJaVkxxdkQ4TEE9PSIsInZhbHVlIjoiSFF3ZG91ZWJWUXRKN3R0cDR0UGVCWXlSN05HTjBIWW5TMkFyNzlGYWhJTGtaYUVXVHNwMUZvODluTVVEb0hzKzdhS0tqK2k2SHF3QjJYeTA5cE5zcDVHclFUclN3cEpDZXVNMXlUcFo4WFZjL3RjUHk5VytiN0l1SllBUVkxT1oiLCJtYWMiOiJhMjRkNjlmYTg4OGQyYTdmZWU5N2E1NDA4ZTBhNzIyYWZiMzdjZGUyY2E1YzNlOTE1YTAxMGY1NWYxYTBlMTc3IiwidGFnIjoiIn0%3D; expires=Mon, 03 Mar 2025 08:24:16 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IkhYMUdQMVcwbFJhSTJaVkxxdkQ4TEE9PSIsInZhbHVlIjoiSFF3ZG91ZWJWUXRKN3R0cDR0UGVCWXlSN05HTjBIWW5TMkFyNzlGYWhJTGtaYUVXVHNwMUZvODluTVVEb0hzKzdhS0tqK" 1 => "alphaeurekaselectnet_session=eyJpdiI6ImhpVVRkOTZiSUtINGJPYm5Fc3pNN0E9PSIsInZhbHVlIjoibnlWRWdZM3UzK2Q2MGFSTVVKV2ZZRDNkUm5pZm1MR2JLR3BxY1ZsejNteWdtZUl4RDVYMk9qZzEyTzBXRUxaV210UndLNXU0UlNVc3orWVFiU0R4TEVTSFIvTC91YlV4dGRjeXRJT285WERTc0kzRElYcVBoaHJXeUV5WWNkOVYiLCJtYWMiOiIxYTMxMzMzNGZhMzcwMjU5ZjA5NWU5MmFkNzM3MTAzMGM0YjI5MTYzMTRkZTY0N2VjMmY2ZmY3MDg3NGVjZmM4IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6ImhpVVRkOTZiSUtINGJPYm5Fc3pNN0E9PSIsInZhbHVlIjoibnlWRWdZM3UzK2Q2MGFSTVVKV2ZZRDNkUm5pZm1MR2JLR3BxY1ZsejNteWdtZUl4RDVYMk9qZzE" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkhYMUdQMVcwbFJhSTJaVkxxdkQ4TEE9PSIsInZhbHVlIjoiSFF3ZG91ZWJWUXRKN3R0cDR0UGVCWXlSN05HTjBIWW5TMkFyNzlGYWhJTGtaYUVXVHNwMUZvODluTVVEb0hzKzdhS0tqK2k2SHF3QjJYeTA5cE5zcDVHclFUclN3cEpDZXVNMXlUcFo4WFZjL3RjUHk5VytiN0l1SllBUVkxT1oiLCJtYWMiOiJhMjRkNjlmYTg4OGQyYTdmZWU5N2E1NDA4ZTBhNzIyYWZiMzdjZGUyY2E1YzNlOTE1YTAxMGY1NWYxYTBlMTc3IiwidGFnIjoiIn0%3D; expires=Mon, 03-Mar-2025 08:24:16 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IkhYMUdQMVcwbFJhSTJaVkxxdkQ4TEE9PSIsInZhbHVlIjoiSFF3ZG91ZWJWUXRKN3R0cDR0UGVCWXlSN05HTjBIWW5TMkFyNzlGYWhJTGtaYUVXVHNwMUZvODluTVVEb0hzKzdhS0tqK" 1 => "alphaeurekaselectnet_session=eyJpdiI6ImhpVVRkOTZiSUtINGJPYm5Fc3pNN0E9PSIsInZhbHVlIjoibnlWRWdZM3UzK2Q2MGFSTVVKV2ZZRDNkUm5pZm1MR2JLR3BxY1ZsejNteWdtZUl4RDVYMk9qZzEyTzBXRUxaV210UndLNXU0UlNVc3orWVFiU0R4TEVTSFIvTC91YlV4dGRjeXRJT285WERTc0kzRElYcVBoaHJXeUV5WWNkOVYiLCJtYWMiOiIxYTMxMzMzNGZhMzcwMjU5ZjA5NWU5MmFkNzM3MTAzMGM0YjI5MTYzMTRkZTY0N2VjMmY2ZmY3MDg3NGVjZmM4IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6ImhpVVRkOTZiSUtINGJPYm5Fc3pNN0E9PSIsInZhbHVlIjoibnlWRWdZM3UzK2Q2MGFSTVVKV2ZZRDNkUm5pZm1MR2JLR3BxY1ZsejNteWdtZUl4RDVYMk9qZzE" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "1WulBh2r268AuVAGhFjwrlGQMMCvusHwtgOR8hBC" "uc_cart_id" => "dbd40853380655cc1a0f7b1c6496ab15" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/12821" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-28 20:24:16GET/chapter/128211121917