Presentation
Right neck swelling and mild shortness of breath for 3 months.
Patient Data
A mass projects over the right superior mediastinum with indistinct borders along its superior margin and above the clavicle. The lateral border of the mass below the clavicle is sharp and well defined. The trachea is displaced to the left side by the mass.
Positive cervicothoracic sign raises suspicion of retrosternal/retrotracheal thyroid gland.
A large heterogeneously enhancing mass extends from the right inferior thyroid lobe into the right sided superior mediastinum to the level of T5 vertebra. This exophytic-appearing lesion has similar appearance and density to the thyroid parenchyma. Multiple thyroid nodules with peripheral wall calcification.
Anteromedially, slight compression onto the posterior part of intrathoracic trachea causing mild stenosis. No encasement of great vessels.
Focal lung consolidations in both upper lobes. Mild degree of bilateral pleural effusion.
Cardiomegaly.
Gross ascites.
Annotated images for the chest radiograph and CT scan (coronal view) to describe the appearance of cervicothoracic sign.
Case Discussion
Positive cervicothoracic sign is useful sign to formulate the correct differential diagnosis for mass at the upper lung zones, which later confirmed with more advanced cross-sectional CT scan.