Differential Diagnosis for Multiple Avascular Hypoechoic Smoothly Demarcated Parallel Solid Nodules
- Single most likely diagnosis
- Thyroid nodules (e.g., multinodular goiter): This is a common condition where multiple nodules form in the thyroid gland, which can appear as hypoechoic, smoothly demarcated, and parallel on ultrasound.
- Other Likely diagnoses
- Adrenal nodules: Multiple adrenal nodules can appear hypoechoic and smoothly demarcated on ultrasound, although they are less common than thyroid nodules.
- Ovarian cysts or nodules: In females, multiple ovarian cysts or nodules can appear as hypoechoic, smoothly demarcated structures on ultrasound.
- Testicular microlithiasis: In males, testicular microlithiasis can cause multiple small, hypoechoic nodules, although these are typically not as large as those seen in other conditions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Metastatic disease: Although less likely, metastatic disease to various organs (e.g., liver, lymph nodes, or adrenal glands) can present with multiple hypoechoic nodules and must be considered, especially in patients with a known primary malignancy.
- Pheochromocytoma: A rare but potentially life-threatening condition where a catecholamine-secreting tumor forms in the adrenal gland, which can appear as a hypoechoic nodule on ultrasound.
- Rare diagnoses
- Hydatid cysts: A parasitic infection caused by Echinococcus granulosus, which can form multiple cystic structures in various organs, including the liver, lungs, or kidneys.
- Neurofibromas: In patients with neurofibromatosis type 1, multiple neurofibromas can form in various locations, including the skin, soft tissues, or internal organs, and may appear as hypoechoic nodules on ultrasound.