The surgical approach to retrosternal goiters: the role of computerized tomography

Abstract

Objective: To assess preoperative CT scans of patients with a retrosternal goiter, with an objective of identifying features that are likely to predict the need for sternotomy at operation.

Study design and setting: A retrospective review of clinical notes and CT scans of patients who underwent thyroidectomy for retrosternal goiter at a large district general hospital in the United Kingdom between 1998 and 2002.

Results: Extension of the goiter to the level of the aortic arch, particularly when combined with tracheal involvement or major vessel displacement, increases the likelihood of requiring median sternotomy.

Conclusions: Most retrosternal goiters can be approached through a cervical incision alone. However, extension of the goiter to the level of the aortic arch does appear to increase the likelihood of requiring sternotomy.

Significance: In such cases in which sternotomy is anticipated, the availability of cardiothoracic services would be helpful to avoid patient morbidity.