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Mediastinal goiter

Case contributed by Varun Babu
Diagnosis certain

Presentation

Midline neck swelling went to a local hospital for evaluation of recent onset dyspnea.

Patient Data

Age: 60 years
Gender: Female

Non enhanced CT neck

ct

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

Case Discussion

Clinical examination revealed thyromegaly. She was referred to a higher center for further evaluation.

Ultrasound neck revealed a picture of multinodular goiter with the lower pole of the left lobe of the thyroid not being visualized. Since there was significant dyspnea, she was advised surgical removal. 

The surgeon ordered a preoperative CT neck to assess the retrosternal extension of the goiter.

The importance of reporting the inferior extension of a goiter lies in the surgical management, which is different for substernal and mediastinal goiters.

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 goiter was given in this case.

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