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. 2014;5(8):465-8.
doi: 10.1016/j.ijscr.2014.05.015. Epub 2014 Jun 6.

An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report

Mehmet Aziret  1 , Mehmet Şah Topçuoğlu  2 , Cemal Ozçelik  3 , Muharrem Ozkaya  4
Affiliations

An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report

Mehmet Aziret et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Surgical treatment of benign thyroid diseases need to be followed up closely, since recurrent thyroid nodules can be seen after subtotal thyroidectomy. Intrathoracic goiter (ITG) occurs in 10-30% of patients following subtotal thyroidectomy. In general these goiters are benign, having a malignant rate of only 2-22%. ITG grows slowly but steadily and in its process of development, it narrows the thoracic inlet by compressing the surrounding structures. Most of these can not located in the anterior mediastinum, others located in posterior retrovascular area. Bilateral posterior retrovascular goiters are very rare.

Presentation of case: We report a case involving a 61-year-old woman with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. She had undergone bilateral thyroid lobectomy for a cervical goiter 10 years ago. The mass was removed successfully via median sternotomy without complication. The patient recovered well and was discharged in 1 week.

Discussion: Most anterior mediastinal goiters can be resected through a transcervical approach, but if those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy.

Conclusion: Bilateral recurrent posterior mediastinal and retrovascular large goiters are better resected via sternotomy rather than lateral thoracotomy. The reason for that are the possibility of injury to large vascular structures and the difficulty of their management through lateral thoracotomy when cardiopulmonary bypass needed.

Keywords: Intrathoracic goiter; Median sternotomy; Mediastinum.

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Figures

Fig. 1
Fig. 1
Enlargement upper and middle mediastinum.
Figs. 2 and 3
Figs. 2 and 3
Intraoperative view. Dissection of the left lobe and vascular structures and after thyroidectomy (2), bilateral thyroid nodules are seen (3).
Figs. 4 and 5
Figs. 4 and 5
Comparison of preoperative and postoperative thoracic computed tomographies. Notice the degree of tracheal compression preoperatively (4). Anatomy restored postoperatively (5).
See this image and copyright information in PMC

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