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[Hiatus hernia mimicking an endothoracic goiter in thyroid scintigraphy].
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[Thyroid plasmacytoma with amyloid deposits. Report of a case and review of the literature].
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[Surgery in goiter with a primary mediastinal manifestation].
Eight patients with mediastinal masses and occupational syndrome were presented. Seven were diagnosed prior to surgery, allowing the staff to plan the procedure. The cervical route is advisable. It provides the best exposure that provides the safest surgery, but the incision must often be enlarged for the patient's safety. Results of surgery are excellent, with immediate relief of compressive symptoms. Postoperative infection of the wound is a possible complication. Results of medium- and long-term follow-up lead us to advise concomitant medical treatment along with surgery, given the risk of recurring goiter.
Huge mediastinal goiter.
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Cerebral ischemia from thoracic goiter.
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Intrathoracic goitre. Surgical treatment in an ENT department.
Eighteen consecutive cases of intrathoracic goitres operated in an ENT department during a four-year period from 1977-1981 are presented. Massive intrathoracic extension, with at least half of the gland located below the top of the sternum, was seen in all cases. Seventy-eight per cent of the patients had respiratory symptoms, which, in most cases, was so extreme that periodic or manifest stridor was present. The gland could be extirpated through a wide Kocher's incision in all cases. There was no mortality, only a single case of hypoparathyroidism and no recurrent nerve paresis or other complications. Traditionally operation of intrathoracic goitre is performed in thoracic surgical departments. Sternal splitting or lateral thoracotomy, however, is only necessary in a very few cases. It is concluded that surgical treatment of patients with large intrathoracic extension can be performed with advantage in ENT departments by surgeons experienced in head and neck cancer surgery using the operating microscope to lessen risk of damage to the recurrent laryngeal nerves.
Obstructive sleep apnoea in association with retrosternal goitre and acromegaly.
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Pitfalls in the follow-up of cervical and mediastinal goitres: role of CT imaging.
Four patients with cervical and mediastinal goitres were described. Routine investigation in these patients, including chest X-rays, oesophageal and tracheal X-rays and scintigraphy of the thyroid gland, failed to show significant changes over the years, or underestimated the true extent of the goitres. Three of the goitres caused severe mediastinal compression, evident only on computed tomography (CT) imaging, and requiring urgent surgery. The pros and cons of different diagnostic modalities for imaging cervical and mediastinal goitres are discussed, stressing the importance of CT imaging as exemplified in the cases presented.
Management of retrosternal goitres: results of early surgical intervention to prevent airway morbidity, and a review of the English literature.
We present our experience and also review the world literature on the management of retrosternal goitres (RSGs). There is now irrefutable evidence that almost all RSGs will continue to grow and eventually cause airway compression. We describe the diagnosis, investigation and surgical approach to the management of this condition.
[Intrathoracic goiter--a rare mediastinal tumor].
Intrathoracic, totally ectopic goiters are rare, but have to be considered as a diagnostic possibility in all mediastinal masses. The displacement of the thyroid tissue inferiorly in connection with the embryogenesis of the heart and the large vessels explains the aetiology of the disease. Ectopic goiters are often asymtomatic or oligosymptomatic. They may be classified into two groups according to their location in the anterior or posterior mediastinum. The diagnostic procedures include standard X-ray and CT scan imaging, eventually combined with radionuclide scintigraphy. Once the diagnosis of a intrathoracic goiter is obtained the treatment is surgical (unknown dignity, risk of compression or other symptoms). The approach of choice is through a median sternotomy in case of a anterior location and a posterolateral thoracotomy in case of a posterior location. We discuss the diagnostic and therapeutic approach in 2 patients with mediastinal goiters--one located in the anterior and one in the posterior mediastinum.
Clinical dilemma. Retrosternal goitre.
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A 14-year experience with 6 cm as a criterion for surgical treatment of abdominal aortic aneurysm.
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[Diagnostic and therapeutic aspects of endothoracic goiter (author's transl)].
Among mediastinal tumors requiring operative treatment endothoracic goiters have to be considered as common cause (13.7%) in differential diagnostic aspects next to dysontogenetic and neurogenic tumors. Final diagnosis is best established by chest x-rays in two directions, perhaps with additional barium swallow and a scintigraphy (131I or technetium). Angiography is of no valuable further information concerning tumor identification or operability. The disadvantage refers to unwanted iodine load in case of thyroid malignancy. The operative approach for real mediastinal goiter necessitates partial or total sternotomy or occasionally lateral thoracotomy.
Intrathoracic retroesophageal nodular goiter.
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[Clinical value of endoscopic ultrasound-guided transesophageal fine needle puncture of mediastinal lesions].
BACKGROUND AND OBJECTIVE: As the mediastinum has been a region difficult to access for biopsy, mediastinoscopy has been required in most cases. In a prospective study the value of transoesophageal endoscopic ultrasound (TEUS) guided aspiration biopsy was assessed as an alternative. PATIENTS AND METHODS: TEUS-guided fine-needle aspirations were performed between May 1995 and March 1998 in 35 patients with mediastinal space-occupying lesions. In all cases the conventional endoscopic method or percutaneous puncture-sonography had been impossible or had failed. In one patient it had been performed after a negative mediastinoscopy. RESULTS: In 34 patients (97%) the aspirated tissue cylinder could be evaluated histologically. There were no complications. Malignancy was demonstrated in 24 patients, and there were one case each of sarcoidosis, silicoanthracosis and two cases of retrosternal goitre. In four of seven patients the negative preoperative diagnosis was confirmed at operation or by follow-up. There were two false-negative results and in one patient there has been no definitive diagnosis. The accuracy of the method was thus 91.4%, the positive predictive value for malignancy 88.9% and the negative predictive value for malignancy 72.7%. Ultrasound alone was a poor predictor of malignancy in lymph node enlargement. CONCLUSION: TEUS-guided fine-needle aspiration of space-occupying mediastinal lesions is an effective and low-risk method that can in selected cases shorten the diagnostic process and avoid methods that are expensive or lead to complications such as transpulmonary biopsy guided by computed tomography or mediastinoscopy.