A Thyroglossal Duct Cyst (TGDC) is the most common cause of midline neck masses and is characterized in sonography as an anechoic or hypoechoic well-cir- cumscribed cyst with posterior enhancement. TGDCs mostly occur in children and are easy to spot in them, but the sonographic appearance of TGDCs in adults is variable, ranging from a typical anechoic to a pseudosolid appearance. The presence of a solid component should alert the radiologist to the possibility of a cancer arising from the thyroglossal duct. We report here on our experience with a 58-year-old woman who had a complicated TGDC with a suspicious sonographic appearance of malignancy.