Mediastinal goitre

Case contributed by Dr Varun Babu

Presentation

A middle aged lady with midline neck swelling went to a local hospital for evaluation of recent onset dyspnea. Clinical examination revealed thyromegaly. She was referred to a higher centre for further evaluation. Ultrasound neck revealed a picture of multinodular goitre with the lower pole of left lobe not being visualized. Since there was significant dyspnea, she was advised surgical removal. The surgeon ordered a pre operative CT Neck to assess the retrosternal extension of the goitre.

Patient Data

Age: 60
Gender: Female
CT

Non enhanced CT neck

CT Neck revealed a goitrous left lobe 9cm in its greatest dimension (craniocaudal) extending posterior to the great vessels, 3.4cm below the top of the manubrium. The tracheal axis is shifted to the right and about 2cm below the cricoid cartilage, the trachea is compresssed for a length of 5cm, causing approx. 40% tracheal lumen cross sectional narrowing.

Case Discussion

The importance in reporting the inferior extension of a goitre lies in the surgical management that differs for a substernal vs mediastinal goitre

The following should be reported by the radiologist

  • craniocaudal extent with reference to surgically identifiable landmarks
  • course in relation to great vessels
  • length and extent of tracheal compression
  • displacement/involvement of neck vessels

The final impression of a mediastinal goitre was given in this case. 

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Case information

rID: 17104
Case created: 17th Mar 2012
Last edited: 2nd Oct 2015
System: Head & Neck
Inclusion in quiz mode: Included

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