Superior vena cava syndrome cause by intrathoracic goiter.
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Out of the 220 cases of goiters operated in the clinic 19 were partially or totally intra-thoracic, as follows: --totally intra-thoracic: 7 cases; --partially intra-thoracic: 12 cases, of which: mediastino-cervical: 2 cases; cervico-mediastinal: 10 cases. Five of the totally intra-thoracic goiters were in the anterior mediastinum, while two were in the posterior mediastinum, in a retro-oesophageal position. Three of the 19 intra-thoracic goiters were malignant. The symptomatology, the diagnosis and especially the therapeutical attitude are discussed.
Twenty-nine patients suffering from intrathoracic goitre who were admitted to a thoracic surgical clinic were studied. Most patients had respiratory complaints but as many as 28% did not have any symptoms and their goitres were revealed on routine chest X-rays. Only seven patients were operated upon with a thoracic approach, usually a sternal split. All others were operated upon with a cervical collar incision. Three of the goitres were toxic and one malignant. Two of the patients died, one when inducing anaesthesia and the other of pulmonary embolism six days after the operation. General anaesthesia with endotracheal intubation is preferred when operating for intrathoracic goitre. The operation is started with a cervical collar incision and the patients prepared for a sternal split. Lateral thoracotomy may be necessary only when the mass is situated in the posterior mediastinum.
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