Presentation
Work up for chest pain and shortness of breath. Palpable lower neck mass on physical exam.
Patient Data
The thyroid gland is nodular and markedly enlarged, particularly in the right lobe and extends intra-thoracic until the level of the right lung hilum. The mass exerts pressure on the mediastinal and lower cervical vascular structures without invasion or encasement, causing chest wall dilated collateral vessels.
In addition, the mass causes mild right to left shifting of the midline cervical and upper mediastinal structures and adjacent lung collapse.
Moderate pleural effusion is seen on the right side.
An enlarged lymph node with SAD of 11 mm is noted in the prevascular region.
No pulmonary nodule is identified.
Case Discussion
Multinodular goiter with a massive intrathoracic extension. The patient went to have a total thyroidectomy with a thoracic approach and sternotomy. Further histopathology evaluation confirmed multinodular goiter with areas of papillary thyroid carcinoma.
CT scan is not a primary modality for diagnosis but may be helpful in thoroughly characterizing the extent of substernal (retrosternal) goiter.
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