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PubMedDate not supplied

[Cervico-mediastinal goiter].

We analyzed 824 patients treated by thyroidectomy in our Institute from January 1995 to December 2000. We observed the presence of cervicomediastinal goiter in 117 patients (14.9%), 92.7% of whom presented euthyroidism. Sternotomies were performed in 15 patients (10 midline and 5 hemi-clamshell). On the basis of our own experience and the reports in the literature, we analyse the diagnostic and surgical approach to the therapy of cervicomediastinal goiter.

Diagnosis, Differential↗
PubMedDate not supplied

Non-recurrent inferior laryngeal nerve.

Surgical damage to the inferior laryngeal nerve is one of the most feared complications of thyroid surgery. Prevention of surgical injuries requires systematic, early exposure of the inferior laryngeal nerve. A detailed knowledge of anatomical variations is necessary. Non-recurrent inferior laryngeal nerve is a rare anomaly on the right side and is exceptional on the left. Whereas the typical course of the inferior laryngeal nerve is due to the embryological development of the aortic arch and supra-aortic vessels, non-recurrence is associated with a vascular anomaly such as a right retro-oesophageal subclavian artery. The nervous anomaly on the left side is possible only with the occurrence of cardiac dextroposition (situs viscerum inversus) and a left retro-oesophageal subclavian artery. The situation is more dangerous when a non-recurrent branch of the inferior laryngeal nerve is associated with a recurrent branch. This anomaly does not appear to be associated with a vascular anomaly in all cases. The authors describe three cases of right non-recurrent inferior laryngeal nerve observed and one recent case of combined non-recurrent and recurrent nerve, highlighting the anatomical and surgical features of this anomaly.

Adult↗
PubMedDate not supplied

[Complex radiation diagnosis of the intrathoracic thyroid].

The study deals with a complex radiation diagnosis of mass lesions of the distopic thyroid. Forty five patients with mass lesions of the anterior mediastenum were examined. They were 28 with retrosternal and intrathoracic goiter, 6 with teratodermoid tumors, 11 with cysts of the anterior mediastenum. A complex radiation study included serial routine X-ray tomography in 2 standard projects, sonography, computed tomography. The diagnosis was verified on the basis of transthoracic and transbronchial needle biopsy with compulsory morphological confirmation. An intergroup comparison has shown that X-ray study is a screening method to detect a tumor, to define its site and its relationship with the adjacent organs. Ultrasound study reveals pathognomonic signs of the distopic goiter. Of the greatest informative value is X-ray CT which allows one to state about the structure of a tumor and its densitometric signs.

Biopsy, Needle↗
PubMedDate not supplied

Transclavicular access as an adjunct to standard cervical incision in the treatment of mediastinal goitre.

There are cases in which resection of cervico-mediastinal goitres requires additional thoracic access as an adjunct to standard transverse cervicotomy, and typically this takes the form of sternotomy or thoracotomy. The authors propose transclavicular access as an alternative to thoracotomy or sternotomy access for the removal of such goitres. This technical variant is performed by means of resection of the middle third of the clavicle and extraperiosteal disarticulation. They report a case of cervicomediastinal or "plunged" goitre associated with mediastinal metastasis from a follicular thyroid carcinoma in a 77-year-old woman, in whom this technical variant was used. They conclude by stressing the greater effectiveness, ease of execution and relatively limited "aggressiveness" of the technique in comparison with other ways of reaching the mediastinum. The variant proves effective in solving a number of technical, functional and aesthetic problems.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

[Surgical treatment of acute respiratory failure caused by mediastinal goiter. Clinical experience and results].

In the regions where goitre is endemic, onset of the disease with acute respiratory insufficiency caused by thyroid compression is an uncommon situation requiring a rapid diagnosis and urgent surgical treatment. From January 1997 to December 2000 we observed 81 patients with thyroid pathologies, (69 males and 12 females; mean age 64 years). We found colloid-cystic goitre in 39 cases, adenomatous goitre in 26, carcinoma in 12, Hürthle's cell tumours in 3 and inflammatory disease in 1. All patients underwent thyroidectomy. Nine patients (11%) presented acute respiratory insufficiency caused by thyroid compression, with various associated phonesis disorders; in these cases we performed emergency surgery with postoperative maintenance of tracheal intubation or tracheotomy or the possible positioning of a self-expanding tracheal stent. In these 9 patients there were 4 deaths (44%), 3 in the immediate postoperative period and one after 10 months. We also observed one hydropneumothorax. Functional recovery was achieved in the remaining 5 patients. The treatment of this clinical picture requires urgent tracheal intubation, before the use of diagnostic tools, and it is important to maintain it after the surgical procedure for as long as is necessary for the tracheal wall to be reconstituted. In the severest cases a temporary tracheotomy is needed or the positioning of a tracheal stent, which offers a valid and effective alternative.

Acute Disease↗
PubMedDate not supplied

["Forgotten" goiter: clinical case and review of the literature].

"Forgotten" goitre is an extremely rare disease. It is a mediastinic thyroid mass found after total thyroidectomy. In this paper we report a case of "forgotten" goitre and review the various diagnostic and therapeutic problems posed by the condition. A number of possible solutions that can be implemented for this disease are identified.

Goiter, Substernal↗
PubMed2002

Pattern of intrathoracic goiter in Ibadan, Nigeria.

This study is to review the pattern of intrathoracic goiter in a large black population. In a retrospective review, the cardiothoracic unit managed ninety-eight primary mediastinal masses of which sixteen patients with intrathoracic goiters were treated during the same period. This constitutes 1.3% of treated goiters and 16.3% of primary mediastinal masses. Seventy-five per cent of the intrathoracic goiters were in association with cervical goiters. Twelve of the intrathoratic goiters were located in the anterosuperior mediastinum, and two in the middle mediastinum. There were three goiters in the posterior mediastinum. Six patients had cervical exploration and median sternotomy, three had cervical exploration and thoractomy, 3 had only thoractomy, two had only median sternotomy for excision. Thirteen patients (81.3%) had either simple colloid or multinodular intrathoracic goiter, one had follicular adenoma, and 2 patients had malignant goiters. One patient had recurrent cervical goiter. The endemicity of thyroid disease does not seem to increase the frequency of intrathoracic goiter.

Age Distribution↗
PubMed2003

A giant retrosternal goiter with severe tracheal compression and superior vena cava syndrome: an operative experience.

The peculiarities in the operation of a giant retrosternal goiter with severe tracheal compression and superior vena cava syndrome are highlighted in this report of a 53 year-old female with a large anterior neck swelling interfering with normal breathing and swallowing. From the initiation of the neck incision, mobilization of the gland and performing the subtotal excisions there was troublesome bleeding. Pneumothorax resulting after delivery of the massive retrosternal portion was managed with an underwater-seal drainage tube.

Airway Obstruction↗