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PubMed1989

Emergency surgical management of retrosternal goiter causing tracheal compression.

Acute tracheal compression caused by mediastinal masses is a rare event. Dyspnea is the most frequent symptom and the treatment of choice is intubation followed by surgical operation. Four cases of acute tracheal compression due to retrosternal goiter are described. All of them underwent emergency surgical treatment. Clinical findings and problems of surgical technique are discussed.

Aged↗
PubMed1989

[Pitfalls of extracapsular thyroid surgery].

The usual landmarks of thyroid surgery are often altered with a goiter. The surrounding tissue may also be subject to variation. Different anomalies the surgeon may encounter are presented along with their management: the recurrent nerve, the external laryngeal nerve, the parathyroids and an intrathoracic goiter. Each case of thyroid surgery must be considered individually, and the ENT surgeon must devote particular attention to assure perfect postoperative vocal cord function.

Goiter, Substernal↗
PubMedDate not supplied

Primary intrathoracic goitre.

A right paratracheal mass in a 56-year-old man was found to be a primary intrathoracic goitre. Pathological examination showed nodular hyperplasia with focal lymphocytic thyroiditis. Enlarged mediastinal thyroid tissue may result from extension of a cervical goitre into the chest and is then called secondary or may develop from ectopic thyroid tissue located in the mediastinum and is then called primary. In the latter case blood supply comes from local intrathoracic vessels and no connections with the cervical gland are observed. Differentiation can be made by ultrasonography, CT scanning or radioisotope scanning. Primary goitres are best operated on by way of a thoracotomy as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision.

Goiter, Substernal↗
PubMed1986

Hyperthyroidism caused by a toxic intrathoracic goiter with a normal-sized cervical thyroid gland.

The rare presentation of hyperthyroidism caused by an intrathoracic goiter with a normal-sized cervical thyroid gland is described. The toxic intrathoracic goiter demonstrated avid uptake of [131I] and [99mTc]pertechnetate, with comparatively faint isotopic accumulation seen in the cervical thyroid. A chest roentgenogram and radioisotope scan should be mandatory in cases of hyperthyroidism having no cervical thyroid enlargement to explore the possibility of a toxic intrathoracic goiter.

Female↗
PubMed1987

[Tumors of the anterior mediastinum--surgical treatment and prognosis].

This paper reports on 96 mediastinal tumors situated exclusively or mainly in the anterior mediastinum. Early surgical intervention is always indicated to establish the diagnosis and to ensure as radical a tumor resection as possible. The surgical approach depends on the tumor size and localization and is made either by sternotomy or thoracotomy. The prognosis depends on the histological classification of the tumors: out of 30 patients with lymphomas, 19 survived as compared to 10 out of 21 patients with thymoma and 15 out of 18 patients with mesenchymal tumors. Of 16 patients with endothoracic and retrosternal goiters, none died of a cause connected with the goiter and nine out of 11 patients with mesodermal tumors survived. The indication for surgery should be established extensively, since one third of the tumors is malignant and the surgical lethality (1.8%) is very low.

Combined Modality Therapy↗
PubMed1979

[Acute dyspnoea by acute thyroid abscess (author's transl)].

Infection is extremely rare in the pathology of the thyroid gland. One case is reported, and a review of the literature has helped to emphasize some specific points. Acute thyroiditis can be misdiagnosed in its initial phase because a fever by itself may not lead to a through examination of the neck, even if a goitre is present; the latter being the site of infection in the case reported. Dyspnoea of laryngeal origin proves to be a dangerous complication of thyroid abscesses. Treatment is always surgical, linked with appropriate antibiotic therapy. In the long run, thyroid function is unaffected.

Abscess↗
PubMed1988

[Forms of the compression syndrome in nodular and retrosternal struma in advanced age].

65 cases with a partially retrosternally localized nodular goitre and with compression syndrome (CS) are discussed. The most often (45 patients) registered complaints are breathing difficulties because of tracheal compression, in 8 further patients bad deglutination prevailed over dyspnoe, 3 patients with a compression of the jugular veins showed oedematous face, cyanosis and other signs testifying for stasis of the superior vena cava. Compression of the cervical truncus sympathicus was the cause of Horner's syndrome in 5 patients, in one person thyroid malignancy led to a coarse voice via infiltration of the recurrent nerve. In an additional group were 10 persons with a partially retrosternally localized recurrent nodular goitre, they were subjected to reoperation. In conclusion, 1. the therapy of choice of a CS is strumectomy 2. a consequent postoperative therapy with thyroid preparations is postulated.

Adult↗
PubMed1988

[Intrathoracic goiter in the posterior mediastinum].

Several examination methods are now available for diagnosis of intrathoracic goiter; diagnosis of suspicion is made by conventional plain radiography of the thorax, clinical findings being often normal or non-characteristic. If the iodine scintigram shows accumulation in the tumor, we can be practically sure of the diagnosis of an intrathoracic goiter. In case of a negative iodine scan we can obtain pointers to the nature of the tissue via CT or MR, especially if a connection between cervical thyroid tissue and intrathoracic mass can be demonstrated. Furthermore, these two methods (CT and MR) enable exact determination of the extension of the goiter and show the topographical relation to the neighbouring organs or their displacement.

Goiter, Substernal↗
PubMedDate not supplied

Fine needle aspiration cytology and immunocytochemistry in a case of intrathoracic thyroid goiter.

Fine needle aspiration (FNA) was performed in the case of a patient with an anterior mediastinal mass. Examination of the smears revealed individual and groups of benign nondiagnostic cells. Surgical removal and histologic examination indicated that the mass was a true intrathoracic thyroid goiter. Subsequent immunocytochemical studies on the FNA smears showed thyroglobulin in the cytoplasm of the aspirated cells. The cytologic findings are presented; while not diagnostic of a thyroidal origin in this case, they serve as a reminder of the wide range of cytologic appearances of colloid nodules and goiters. This case will hopefully heighten the awareness of cytologists and other physicians to the consideration of the possibility of intrathoracic goiter in the differential diagnosis of mediastinal lesions seen in fine needle aspirates.

Biopsy, Needle↗