[Cervico-retrosternal and intrathoracic goiter: diagnosis and treatment].
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A detailed analysis of CT findings with mediastinal thyroid masses is reported. The authors illustrate the CT features that confirm the thyroid origin of this lesions and emphasize the value of the method in the evaluation of this pathology. In a mediastinal mass the CT is helpful to recognize the origin of the lesion as well as it may suggest its malignancy.
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Intrathoracic thyroid cancer is an unusual finding, and few reports are available on this item. Literature data have been reviewed, and some considerations on epidemiologic characteristics of the disease and on its treatment were gained from an analysis of reports based on the files of I Surgical Clinic of the University of Turin, Surgical service of the Oncological Department of the S. Giovanni Battista Hospital and II Pathological Anatomy Service of the University of Turin. No correlation was found between previous thyroid disease, sex, histological findings, previous radiotherapy and incidence of the disease. Older age at the onset and recurrent laryngeal nerve lesions are frequently associated with intrathoracic thyroid cancer; papillary carcinoma is rarely found. Intrathoracic situation is not likely, in Author's opinion, to affect the long term prognosis more than usual risk factors.
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Iodine-123 thyroid scintigraphy allows the diagnosis of a functioning retrosternal goiter in a patient with a mediastinal mass. The case report of a 60-yr-old lady demonstrates this. The correlative values of nuclear magnetic resonance imaging and thyroid scintigraphy in the initial evaluation and continued management of patients with thyroid mediastinal mass are presented. In addition, this observation demonstrates the ability of nuclear magnetic resonance to identify retrosternal thyroid tissue. This may obviate the need for TCT evaluation, which involves both ionizing radiation and iodinated contrast enhancement.
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Intrathoracic goiter remains an interesting diagnostic and surgical problem. A case of a patient with intrathoracic goiter causing a superior vena cava syndrome which resulted in "downhill" esophageal varices and bleeding is presented. This is the 36th case of reported "downhill" esophageal varices and the ninth to cause massive upper gastrointestinal hemorrhage. Intrathoracic goiter is a rare benign cause of "downhill" esophageal varices and bleeding, which can be completely cured by thyroidectomy. It is advisable to consider the addition of a vertical sternotomy in such instances for easier and safer control of the vast collateral venous drainage encountered during removal of the mediastinal component of the tumor.
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