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- Title
A Case of Multinodular Goiter with Posterior Mediastinal Extension.
- Authors
Harirchian, Sanaz; Sambol, Justin T; Bolanowski, Paul JP; Baredes, Soly
- Abstract
Objectives: To review the presentation and management cervicomediastinal goiters with posterior mediastinal extension. Study Design: Retrospective chart review. Methods: Case report and review of the literature. Results: Most cervicomediastinal goiters are located in the anterosuperior mediastinum and can be accessed via a cervical approach or median sternotomy. Goiters with posterior mediastinal extension offer a greater challenge. We present a case of a 62 year old man with a two year history of progressive dyspnea, dysphagia, and hoarseness. CT of the neck noted a large multinodular thyroid, each lobe measuring 8-12 cm, with significant extension into the retrotracheal space and tracheoesophageal groove. On flexible bronchoscopy, a left true vocal cord paralysis and 50-75% tracheal compression was noted. The patient underwent a total thyroidectomy. A sternotomy and posterolateral thoracotomy was necessary to deliver the mediastinal and retrotracheal component. Pathology was consistent with multinodular goiter. Conclusion: Cervicomediastinal goiters are frequently symptomatic, presenting with persistent cough, wheezing, dyspnea and in advanced cases, stridor, superior vena cava syndrome, and dysphagia. The incidence of preoperative vocal cord paralysis with multinodular goiter is rare, usually occurring in patients with carcinoma or prior thyroidectomy. Most intrathoracic goiters need to be resected because of the potential for continued growth and compression of important mediastinal structures, and a small incidence of coexisting malignancy. Resection of these retrosternal goiters with posterior mediastinal extension can be challenging, often requiring a cervical approach, sternotomy and thoracotomy. In our case, a posterolateral thoracotomy was needed in addition to sternotomy to deliver the mediastinal and retrotracheal component.
- Subjects
THYROID diseases; GOITER; DYSPNEA; RESPIRATORY diseases; DEGLUTITION disorders; VOCAL cords
- Publication
Laryngoscope, 2011, Vol 121, Issue S5, pS282
- ISSN
0023-852X
- Publication type
Article
- DOI
10.1002/lary.22238