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Percutaneous Ethanol Injection (PEI) in the Treatment of Thyroid Cysts, Nodules, and Other Neck Lesions

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Book cover Thyroid Ultrasound and Ultrasound-Guided FNA

Abstract

Percutaneous ethanol injection (PEI) was first proposed about 30 years ago for sclerotherapy of different kind of lesions, such as hepatocellular carcinoma, hepatic and renal cysts, adrenal adenoma, and parathyroid hyperplasia. Ethanol exerts its sclerosing properties through cellular dehydration and protein denaturation, which lead to coagulative necrosis and small vessel thrombosis. As a consequence, hemorrhagic infarcts and reactive fibrosis are the prevailing histological changes described in tissues exposed to ethanol. In the thyroid gland, the first documented use of PEI for treating thyroid cysts dates to 1989 (Period Biol 91:1116–1118, 1989); shortly after, this technique was also suggested as an alternative therapeutic option to surgery and radioiodine for the treatment of autonomous functioning nodules. Since then, PEI sclerotherapy of thyroid cysts has gained a world-wide diffusion, whereas the fortunes of PEI as a candidate first-line therapy for toxic and pre-toxic solid nodules have gradually faded. PEI treatment of thyroid cysts will therefore constitute the heart of the present chapter. PEI has also proved to be quite effective in treating other neck lesions, like thyroglossal duct cysts, enlarged parathyroid glands, and metastatic lymph nodes. These applications of PEI will also be briefly discussed.

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Authors and Affiliations

  1. Endocrine Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy

    Andrea Frasoldati MD

  2. Endocrinology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy

    Roberto Valcavi MD, FACE

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  1. Andrea Frasoldati MD
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  2. Roberto Valcavi MD, FACE
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Correspondence to Roberto Valcavi MD, FACE .

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Editors and Affiliations

  1. University of Central Florida, North Orange Ave. 2921, Orlando, 32804, Florida, USA

    H. Jack Baskin, Sr.

  2. Endocrinology Associates, North 3rd Avenue 3522, Phoenix, 85613, Arizona, USA

    Daniel S. Duick

  3. Thyroid Center of New Hampshire, Coliseum Avenue 5, Nashua, 03063, New Hampshire, USA

    Robert A. Levine

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Frasoldati, A., Valcavi, R. (2013). Percutaneous Ethanol Injection (PEI) in the Treatment of Thyroid Cysts, Nodules, and Other Neck Lesions. In: Baskin, Sr., H., Duick, D., Levine, R. (eds) Thyroid Ultrasound and Ultrasound-Guided FNA. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4785-6_14

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  • DOI: https://doi.org/10.1007/978-1-4614-4785-6_14

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