Retrotracheal mediastinal goiter with contralateral extension.
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A patient with chronic cough and recent dysphagia was found to have a retrotracheal mass extending into the visceral mediastinum on chest roentgenogram. A computed tomographic scan confirmed a retrotracheal lesion, which was believed to be of lymphatic origin. A thyroid scan demonstrated downward displacement of the left lobe but little uptake in the mass. Histological findings of mediastinal biopsies were inconclusive. A large retrotracheal thyroid adenoma was easily excised through a right thoracotomy. The approach to diagnosis and, in cases of doubt, the safety of surgical access through thoracotomy for thyroid lesions in this unusual site is discussed.
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The surgical management of posterior mediastinal goiters can pose considerable technical difficulty. We illustrate a method of sterile spoon extraction that can facilitate the cervical or limited cervicomediastinal approach to these lesions.
Intrathoracic goitres may cause a variety of symptoms caused by compression of the trachea, neural structures, blood vessels and the oesophagus. A case history is presented of a patient with a recurrent goitre after subtotal thyroidectomy who displayed partial unilateral phrenic paralysis, which subsided after a second subtotal thyroidectomy. Compression of the phrenic nerve appears to be a very rare manifestation of an intrathoracic goitre and thus far has never been reported.
Two cases of recent-onset dyspnea and wheezing initially treated with bronchodilator therapy for presumed reactive airway disease are presented. Plain-film chest radiographs subsequently demonstrated mediastinal masses causing extrinsic tracheal compression. The first patient had inoperable poorly differentiated squamous cell carcinoma resistant to radiotherapy. The second patient underwent resection of a substernal multinodular goiter with complete resolution of symptoms. The physician should always entertain the diagnosis of upper airway obstruction in all adult patients with new-onset wheezing. New-onset adult wheezing of uncertain etiology should prompt the physician to refer the patient for pulmonary function testing with flow-volume loops.
We report a case of a 68-year-old woman with a 16-year history of a benign goiter. The patient presented with hematemesis and a clinically evident superior vena cava syndrome. Preoperative evaluation demonstrated upper esophageal varices and large posterior mediastinal goiter. The patient underwent successful resection of the mass with complete resolution of both the superior vena cava syndrome and "downhill" varices.
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We report a case of an ectopic intrathoracic goiter in a 79-year-old human. This uncommon finding presented as a symptomatic paratracheal mass that was resected using thoracoscopic techniques without complication.
Primary mediastinal ectopic goiters are very rare. We report a case in which an ectopic goiter with blood supply from the thoracic vessels necessitated a transternal approach for removal, resulting in a favorable outcome.
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Benign lesions of the mediastinum rarely produce obstruction of the innominate vessels. Two patients with intrathoracic goitre are described who presented with the superior vena cava syndrome. Venography in each case demonstrated the extent of obstruction and degree of collateral circulation. Early recognition of the association of intrathoracic goitre and superior vena caval obstruction may lead to clinical improvement with surgical treatment.
Currently, the vena cava superior syndrome (VCSS) is mainly of oncologic origin. We report here four cases of this syndrome caused by intrathoracic multinodular goiter. All patients had compressive symptoms, particularly of the oesophagus and trachea. Axial CT was the imaging technique that delineated the intrathoracic multinodular goiter compressing brachiocephalic vessels. Surgery (total thyroidectomy) was used and all compressive symptoms resolved.
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