Posterior Mediastinal Goiter

Shahian, David M.; Rossi, Ricardo L.

doi:10.1378/chest.94.3.599

Cited by 44 publications

(25 citation statements)

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“…[2][3][4][5] Despite retrosternal goiters are mostly localized at the anterior of innominate artery and vein, some cases with posterior mediastinally (10%-15%) placed retro-tracheal component are reported. 6,7) In the last decade, almost 1012 thyroid operations have been performed with various indications in our hospital while 54 (5%) of them were retrosternal localization. Eight of the 54 (7%) patients were necessitate median sternotomy or thoracotomy to remove the thyroid lesions.…”

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confidence: 99%

When is Transthoracic Approach Indicated in Retrosternal Goiters?

Kılıç

Fındıkçıoğlu

Ekici

et al. 2011

ATCS

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Purpose: It is critical to differentiate among pathologies of substernal thyroid gland diseases because surgical approaches (i.e., median sternotomy or thoracotomy) might also include a cervical incision. The aim of this study was to analyze the features of patients with goiter who underwent a thyroidectomy via a cervical incision and a median sternotomy or thoracotomy. Methods: We reviewed 9 cases of thyroid disease in patients undergoing thoracic incisions with or without a cervical incision for varying indications between March 2003 and Jun 2009 were reviewed. Thyroidal masses were removed via a median sternotomy in six patients and thoracotomy in three patients. Split median sternotomy combining thoracotomy was performed in 1 patient. Cervical incision was added in all patients. Results: Pathologic examination revealed multinodular goiter in 5 patients, thyroid carcinoma in 3, and reidel thyroiditis in 1. All patients were extubated in the early postoperative period. There was no postoperative mortality or morbidity. The mean hospital stay was 8.6 days (range, 4-11 days), and mean follow-up was 24.3 months (range, 4-39 months). Conclusions: We recommend the use of transthoracic approaches, such as median sternotomy and thoracotomy for retrosternal goiter for surgical exposure, because they provide a wide exposure and facilitate removal of the mass. By using median sternotomy and thoracotomy, we can avoid catastrophic results, such as hemorrhage, as well as completely remove malignancies.

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confidence: 99%

When is Transthoracic Approach Indicated in Retrosternal Goiters?

Kılıç

Fındıkçıoğlu

Ekici

et al. 2011

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“…An unexpected intrathoracic bleeding is of course difficult to control through a cervical incision and is therefore an indication for sternotomy or thoracotomy. Although the original blood supply of the intrathoracic goiter was primarily from the inferior thyroid vessels, a collateral mediastinal supply could have developed [13,14]. Furthermore, when the goiter develops in the right posterosuperior space of the mediastinum, it can adhere intimately to the superior vena cava and the azygos vein, and the transcervical removal could result in injury to these structures.…”

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Thyroid carcinoma in intrathoracic goiter

Nervi

Iacconi

Spinelli

et al. 1998

Langenbeck's Archives of Surgery

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“…It is estimated that goiter may constitute from 10% to 15% of all tumours of mediastinum. In most cases (75-95%) it is located in anterior mediastinum, in front of major vessels and recurrent laryngeal nerves (5,6,7). In other cases goiter may be located in posterior mediastinum, in retrotracheal or retroesophageal position.…”

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“…Sucha a goiter comprises about 4% of tumors of posterior mediastinum and 10-25% of all cases of intrathoracic goiters. The majority of cases of goiter in posterior mediastinum is located on the right side, what probably is a result of pushing that way the goiter descending from the neck by the aortic arch and major vessels (6,7). Despite the presence of pathological mass in the madiastinum, up to 40% of patients show asymptomatic course.…”

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confidence: 99%

“…In about 22% of cases, a partial superior sternotomy is neccessary, less frequently longitudinal sternotomy, in about 8% of cases the thoracotomy supported by cervicotomy is required (5,6,10). Anaesthesiological problems caused by difficult intubation and serious complications of postoperative period such as respiratory insufficiency caused by flaccid trachea (tracheomalacia) released from compressing goiter mass or as a result of the injury of one or both reccurent laryngeal nerves ought not to be underminded.…”

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Intrathoracic Thyroid Goiters

Jabłoński¹,

Wawrzycki²,

Brocki³

et al. 2010

Polish Journal of Surgery

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In this article, the difficulties in treatment of 18 patients with intrathoracic thyroid goiters were discussed. the aim of the study were: defining the etiology and symptomology of goiters within the chest in the own material, conducting the analysis of the diagnostic efficiency, the evaluation of the early results of surgery and postoperative complications. material and methods. The research material included 18 patients with intarhoracic thyroid goiters after surgical treatment (mediastinal goiters, ectopic goiters). The cases of retrosternal goiters were not analyzed. There was carried out the retrospective analysis of the medical documentation of goiters etiology, the frequency of dominating clinical symptoms, value of diagnostic methods, early effects of surgical treatment and postoperative complications. Results. In the years 2004-2008, operations were performed on 14 women and 4 men with intrathoracic goiters, aged from 34 to 82. The average age of patients was 51.1. The etiology of intrathoracic thyroid goiters were as follows: thyroid goiters (struma nodosa) -55%, adenoma and thyroid goiters -17%, thyroid cancer (ca papillare) and thyroid goiters -11%, ectopic thyroid gland -11%, thyroid goiters and thyroid inflammation -6%.The majority of the material were cases of a cervico-mediastinal thyroid gland, only 2 patients were diagnosed with an ectopic thyroid gland located in the mediastinum with no connection with the cervical thyroid. The local symptoms of compression on intrathoracic organs were mostly observed in the clinical picture, 22% of patients were asymptomatic. The diagnostic process included the estimation of the hormonal state and the radiology localised methods among which helical computer tomography was the most valuable. In order to estimate endotracheal intubation conditions 11 patients (61%) underwent brochofiberoscopy. The following accesses were used in the treatment: cervical -3 cases, partial sternotomy -11, longitudinal sternotomy -2, thoracotomy -1, combined thoracotomy with cervicotomy -1. Good treatment results were obtained in all cases. The following complications were noted: a permanent paralysis of the laryngeal nerve -1 case (6%), hypoparathyroidism -1 (6%). conclusions. Thyroid goiters situated inside the chest are a rarely met pathology which may cause serious difficulties in surgical treatment. Patients with this illness require a thorough preparation for the treatment including balancing hormonal perturbations, preventing intubation difficulties and access to the necessary quality of a diagnostics wit purpose of planning the most optimal surgical access and avoiding serious perioperative complications.

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Posterior Mediastinal Goiter

Cited by 44 publications

References 22 publications

When is Transthoracic Approach Indicated in Retrosternal Goiters?

When is Transthoracic Approach Indicated in Retrosternal Goiters?

Thyroid carcinoma in intrathoracic goiter

Intrathoracic Thyroid Goiters

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