Retrosternal goiter
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Presentation
Neck swelling associated with dyspnea and palpitation
Patient Data
Both thyroid lobes are enlarged more on the left side which extends downward to abut the aortic arch. Multiple cystic areas and calcification within.
The gland extends retrosternally on the left side.
Mild external compression and displacement of the trachea.
Case Discussion
Benign retrosternal or substernal goiters are extensions of a thyroid goiter behind the manubrium sterni. This type of goiter is associated with tracheal and esophageal compression and during surgery may result in injury to the recurrent laryngeal nerve and vocal fold paralysis.
There is almost always continuity with the normally located thyroid gland, attenuation is typically 70-85 HU, and enhancement is intense and persistent. Cysts and calcification may be present.
Malignancy can manifest with local invasion and lymphadenopathy.
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