Mimickers of Pathologic Calcifications and Uncommon Hyperechoic Lesions on Neck Ultrasound: A Pictorial Essay

Ultrasound is essential for distinguishing malignant from benign thyroid nodules by identifying suspicious features like microcalcifications and macrocalcifications. Microcalcifications strongly indicate malignancy, while entirely calcified nodules ≥ 1 cm show an 18.4%–23.3% malignancy risk. However, not all hyperechoic lesions are calcifications. Misinterpretation of these lesions can lead to unnecessary invasive procedures like fine needle aspiration or core needle biopsy. This review highlights hyperechoic structures and lesions and their causes, helping distinguish true pathologic calcifications. Probe rotation, posterior shadowing assessment, swallowing tests, and integrating with other imaging modalities can also help to avoid misdiagnoses and ensure appropriate clinical decisions.