Background: Accurately diagnosing thyroid nodules is vital for preventing unnecessary surgeries and providing prompt therapy. Although fine-needle aspiration cytology (FNAC) and ultrasonography (US) are widely used diagnostic methods, their reliability is questioned. This study investigates the effectiveness of US and FNAC in thyroid nodule diagnosis and differentiates benign from malignant nodules in relation to final histopathological diagnosis. Method: A retrospective study including 307 adult patients with thyroid diseases who underwent neck US and FNAC before surgery was conducted between April 2019 and May 2023. The diagnostic efficacy of US, FNAC, and their combination usage was compared to histopathological results. Result: Histopathological findings revealed that 187 (61%) cases were benign, while 120 (39%) were malignant. The US features of ‘taller-than-wider’ forms and hypoechoic appearance had the highest diagnostic accuracy in characterizing malignant thyroid nodules, with 83 and 73% accuracy, respectively. The combination of US parameters demonstrated high sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 88.33, 63.10, 60.6, and 89.4%, with a statistically significant area under the ROC curve (AUC: 0.828, P <0.001) than individual parameters. FNAC’s sensitivity, specificity, PPV NPV, and accuracy in detecting malignant lesions were 50, 95, 86, 75, and 77%, respectively, with acceptable discrimination and statistical significance (AUC: 0.723, P <0.0001). The combination of US parameters and FNAC significantly improved the AUC value (AUC: 0.878, P 4 cm), ‘taller-than-wider’, infiltrative margins, and microcalcifications were risk factors for malignancy in thyroid nodules and were statistically significant (all P -values <0.05). Conclusion: Combining US characteristics with FNAC results can afford the maximum analytical accuracy in distinguishing benign from malignant thyroid nodules. This strategy is practical due to its simplicity, minimal invasiveness, and cost-effectiveness, enabling robust management regimens and avoiding additional surgical procedures.

Background: Renal artery aneurysms (RAAs) are uncommon visceral arterial lesions whose management depends on symptoms, patient-specific rupture risk, and arterial anatomy. Markedly high origin renovisceral arteries may further complicate endovascular access and reconstruction. This report describes the management of a symptomatic RAA in a young woman with multifocal aneurysmal disease and unusual renovisceral arterial origins at the 11th and 12th thoracic vertebral levels (T11–T12). Case presentation: A 35-year-old woman presented with intermittent right loin pain. Computed tomography angiography demonstrated multiple right renal artery aneurysms, the largest measuring 1.7 cm, together with a 0.6-cm left renal artery aneurysm and a 0.67-cm superior mesenteric artery aneurysmal dilatation. The celiac trunk, superior mesenteric artery, and both renal arteries originated unusually high at the T11–T12 level. An initial trial of right renal artery stenting through right brachial access was technically difficult. Selective angiography after difficult cannulation demonstrated contrast extravasation from a minute right renal artery perforation. The patient remained hemodynamically stable; heparin was reversed with protamine, and repeat angiography 5 min later demonstrated complete sealing without further extravasation. The procedure was therefore aborted with close inpatient observation. Definitive treatment was achieved by ligation of the right renal artery aneurysmal segment and a retrocaval aorta-to-right renal artery bypass using a reversed great saphenous vein graft. At six months, the graft remained patent with preserved renal perfusion and no recurrence of the presenting symptom. Conclusions: This case demonstrates how extreme renovisceral anatomical variation, multifocal aneurysmal disease, and adverse arterial characteristics can limit the feasibility of endovascular treatment. In selected patients in whom secure endovascular access or renal branch preservation cannot be achieved, open reconstruction remains an effective renal-preserving option. Long-term surveillance is important because of the remaining untreated aneurysmal lesions and the limited duration of follow-up in this report.