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PubMed2001

Evaluation of substernal goiters using computed tomography and MR imaging.

Computed tomography and MR imaging are valuable techniques for determining the presence and extent of substernal goiters, their impingement on adjacent structures in the neck and chest, and whether mediastinal masses are thyroidal in origin. This article discusses the advantages and disadvantages of each technique and the radiologic characteristics of substernal goiters. Radiographic examples of both techniques are included to illustrate common clinical settings. Finally, suggestions for choosing which patients will benefit from scanning and which technique will safely provide the maximum information in various clinical settings are discussed.

Goiter↗
PubMed2003

Giant substernal goiter with chylothorax.

A 60-year-old woman presented with a huge goiter extending from the lower jaw to the diaphragm. Right pleurocentesis produced chylous fluid. A cervicothoracic incision was used to totally excise the substernal goiter, with near-total excision of the cervical goiter, and repair of the lymphatic leakage.

Chylothorax↗
PubMed1994

[Substernal goiter: diagnostic and therapeutic problems (apropos of a personal series of 585 interventions)].

This retrospective study is based on a personal experience of 585 operations performed between 1958 and 1993. The diagnosis and topographic evaluation of the thoracic extension of a goiter were greatly improved by the development of the new imaging technics (CT Scan and RMN). Those rather expansive and complex technics were not necessary in 505 cases (86.3%), the diagnosis and topographic evaluation being easy from the conventional tests (X-ray, echography, scintigraphy). But in 80 cas (13.7%) either the diagnosis or the topographic evaluation were difficult or mistaken because Scan or RMN were not yet available or were not used (20 thoracic extensions overlooked; 26 separated thoracic goiters; 24 crossed thoracic extensions; 5 massive degeneration of thoracic extension; 5 false thoracic extension simulated by a mediastinal tumor). The surgical ablation of the substernal goiter could be achieved through a simple cervical approach in 96.4% of the operations. In 21 cases it appeared necessary to prolong the cervicomy by a median sternotomy (total and extrapleural sternotomy in all cases). The transternal approach was imposed in 9 cases by a profound and voluminous thoracic extension in contrast with a small cervical thyroid. In 5 cases, the reason was a massive malignant degeneration of the thoracic extension. In 7 patients the operation was done for a mediastinal redux after a previous cervical thyroidectomy having overlooked the thoracic extension. In spite of all the difficulties, all operations were successful with no mortality and a low morbidity (although slightly higher than the overall morbidity of thyroid surgery).

Goiter, Substernal↗
PubMed1985

Parallax error in pinhole thyroid scintigraphy: a critical consideration in the evaluation of substernal goiters.

Parallax error is found to be another pitfall in pinhole thyroid scintigraphy, i.e., a substernal goiter may appear between the thyroid cartilage marker and the suprasternal notch marker. Unless one is aware of this pitfall, a substernal extension of the thyroid may not be realized or be seriously underestimated in its size and extent. We illustrated the parallax error using a thyroid phantom. An illustrative case is shown.

Diagnostic Errors↗
PubMed2003

Thyroid abscess associated with a substernal goiter. Case report.

An abscess associated with an intrathoracic goiter is an extremely rare condition. The authors report a case of a thyroid abscess complicated by acute dyspnea and asphyxia in a patient of geriatric age with a substernal goiter. Surgical therapy was necessary to obtain a correct diagnosis and an effective treatment.

Abscess↗
PubMedDate not supplied

Management of an ascending aortic aneurysm with coronary artery disease and tracheal compression from a substernal goiter.

We report the case of a 61-year-old female, who presented with a history of chronic fatigue, dyspnea on exertion, a widened mediastinum with tracheal deviation on chest X-ray, and a neck mass. After a diagnostic workup, the patient was found to have a paratracheal mass extending into the chest in addition to a 6.5 cm ascending aortic aneurysm with aortic insufficiency, and a 70% stenosis of the right coronary artery. She underwent successful resection of a substernal goiter via a neck incision facilitated by a previously performed sternotomy for a concomitant ascending aortic root replacement and a bypass utilizing the RIMA to the distal RCA.

Aorta↗
PubMed2003

[Treatment of substernal goiter. Our experience].

The Authors, after having reviewed substernal goitre natural history, report their five-year experience with this disease, underlining clinical features, therapeutic management, positive results. They examine the several proposed classifications and stress haemodynamic and respiratory complications. At last they shortly discuss about diagnostics and, mainly, about correct therapeutic approach which has two aims to resolve the symptomatology and to prevent relapses.

Female↗
PubMed1992

Large parathyroid functioning carcinoma (1,200 g) presenting as a substernal goiter.

Parathyroid carcinoma is a rare tumor responsible for 0.5-5% of primary hyperparathyroidism. It is usually small (not more than 27 g) and the precise diagnosis of malignancy is made when local or distant metastases are found. We describe a case of a 37 yr old male presenting with a substernal goiter and no specific symptoms except hypertension. This mass had cysts and calcifications and it was in the anterior upper mediastinum. The patient had severe hypercalcemia (Ca greater than 14 mg/dl), high PTH levels and mild renal failure. Bone scanning showed signs of hyperparathyroidism. The patient was subjected to total thyroidectomy and removal of the mass en block. The tumor was circumscribed lobulated and mostly cystic. It weighed 1,200 g (380 g after evacuation of cysts) and measured 12 x 9 x 4.5 cm. Histologic examination showed a highly differentiated adenocarcinoma of parathyroid with metastasis in a regional lymph node. Almost 4 years later the patient is alive and well without hypercalcemia and without evidence of distant metastases.

Adenocarcinoma↗
PubMed1997

[Substernal goiters: current diagnostic-therapeutic trends].

The Authors report their experience in the management of substernal goitres as classified by Dor, Carcassonne, Merlier and Eschapasse. Through a literature review an accurate identification of both symptomatologic features and diagnostic protocol is stressed. Surgical procedure is represented in the majority of cases by a nearly total thyroidectomy through a cervical approach. A median total sternotomy is the approach needed to assure the best exposure in case of retrovascular goitre.

Adult↗
PubMed1995

[Dystopic goiter--aspects of definition and surgical therapy].

The incidence in the literature of dystopic goiter depends on classification of the false endothoracic goiter ("substernal goiter") as dystopic and varies from 2 to 20%. From November 1989 through April 1993 we operated on 530 patients with benign nodular goiters. In 84 patients (15.8%) the operation proved a dystopic goiter. We showed that difficulties in comparing our data with published series were due to misnomers of the dystopic goiter. The dystopic goiter comprises the true endothoracic goiters (alliata vera and isolata vera) as well as the false endothoracic goiters (substernal goiter). The precise classification of the dystopic goiter is crucial to an optimal operative strategy reducing postoperative morbidity.

Adolescent↗
PubMedDate not supplied

CT demonstration of isolated mediastinal goiter.

A substernal goiter is a common mediastinal mass that can usually be recognized as contiguous with the body of the thyroid. We report the rare occurrence of a mediastinal goiter that demonstrated no connection with the cervical thyroid on either CT or at thoracotomy. Pathologic examination confirmed this to be an intrathoracic goiter.

Diagnosis, Differential↗
PubMed1990

[Value of investigation tests in thoracic goiters].

Two groups of substernal goiters should be considered fist; the "simples" ones localised in the anterior and superior part of the mediastin. They are most common and less dangerous. By opposition to the "complexes" ones which have relation with the vessels, the airways and the digestive tube. That surgeons would like to approach with security. The study of those retrosternal goiters requires two categories of complementary examinations. One for diagnosis: X Ray standard of the neck and the chest; Echography Biopsy and Radioactive Iodine scintigraphy. Others for localisations to prevent the risks, particularly vascular seeing in the surgery of the substernal goiters: TDM and IRM.

Biopsy, Needle↗
PubMed1999

[Cervico-mediastinal goiter. Our experience].

BACKGROUND: Personal experience about substernal goiter is reported. Stressing laid on the importance of definition: a goiter that is totally or in the most part below the superior thoracic outlet, with normal vascularization. METHODS DESIGN: retrospective evaluation of patients observed in the last six years. SETTING: General Surgery I, Policlinico, University of Palermo. SUBJECTS: four hundred ninety-six thyroidectomies have been performed, 32 patients (6.5%) were found to have substernal goiters. The age was between 42 and 86 years (middle age 59). Male/female = 1/1.9. Asymptomatics were 8 (25%). More frequent symptoms were airway compression (34%), hoarseness (9%), pain (9%), thyrotoxicosis (9%) and dysphagia (3%). INTERVENTIONS: total thyroidectomies have been always performed. MAIN OUTCOME MEASURES: the incidence, symptoms, short and long term complication have been valued. RESULTS: There were no postoperative bleeding or lesion of recurrent nerves or definitive hypoparathyroidism. Postoperative hypocalcemia was observed in 9 patients (28%). Only one temporary hypoparathyroidism (two months) was observed. In 2 patients the histologic examination revealed a papillar carcinoma. There were no intraoperative deaths. CONCLUSIONS: In personal experience the presence of substernal goiter is an indication for total thyroidectomy. The reasons for treating substernal goiter surgically are the following: no effective medical treatment is available; respiratory compromise, thyrotoxicosis, dysphagia, or malignancy can develop in long-standing goiters; surgery, in skilled hands, presents minimal morbidity.

Adult↗
PubMed1997

[Surgery of substernal thyroid goiter].

A retrospective study on 87 substernal thyroid nodules operated between 1965 and 1994 was made. Among them 73.6% were goiters, 14.9% adenoma and 11.5% malignancy. Resection via cervical collar incision was performed in 70% of all cases, sternotomy in 16% and thoracotomy in 14%. A cervical collar incision was adequate in 91% of 43 cases after 1985, only one goiter was completed by sternotomy. Morbidity rate of complications was 41.4%, while the rate of recurrent laryngeal nerve paralysis was 20.7%. Surgery via cervical collar incision for all retrosternal thyroid nodules was advised and sternotomy or thoracotomy are suggested.

Adenocarcinoma, Follicular↗