Ethanol injection causes irreversible tissue damage through cellular dehydration, protein denaturation, coagulative necrosis, and small vessel thrombosis leading to hemorrhagic infarct and reactive fibrosis. The sclerosing properties of ethanol have prompted its use in the treatment of various malignant or benign lesions such us hepatocellular carcinoma, adrenal adenoma, parathyroid adenoma, or hyperplasia. Percutaneous ethanol injection (PEI) for the treatment of thyroid lesions was introduced into clinical practice in 1990. This technique was initially proposed as an alternative to surgery and radioiodine administration in the management of autonomous functioning nodules. While the use of PEI for this purpose has sensibly decreased, ethanol sclerosing properties have been successfully applied in the treatment of thyroid cystic lesions. The present chapter will deal with PEI applications to thyroid lesions, focusing on the treatment of thyroid cysts. PEI therapy of other neck lesions (e.g., parathyroid, lymph nodes) will also be briefly addressed.
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