Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Oct 8:2016:bcr2016217074.
doi: 10.1136/bcr-2016-217074.

Bilateral brachiocephalic vein compression: an unusual and rare presentation of multinodular goitre

Caitlin Jane McNeill  1 , Joseph Dalby Sinnott  2 , David Howlett  3
Affiliations
Case Reports

Bilateral brachiocephalic vein compression: an unusual and rare presentation of multinodular goitre

Caitlin Jane McNeill et al. BMJ Case Rep. .

Abstract

An interesting and rare case where a longstanding multinodular goitre causes sudden onset symptoms of superior vena cava obstruction. The symptoms were caused by bilateral brachiocephalic vein compression against the first rib. The patient's symptoms included upper limb and facial swelling, whereas her lower limbs were not oedematous (figure 1). The patient underwent CT imaging which showed a multinodular retrosternal thyroid filling the space created by the first rib, sometimes known as the thoracic outlet. The goitre expanded sufficiently to compress the brachiocephalic vein on both sides as shown in figures 2 and 3. This prevented venous drainage from the upper limbs and head. The goitre was also large enough to cause deviation of the trachea although there was no airway compromise. This case is interesting as it is very rare for a benign condition such as a multinodular goitre to cause symptoms of superior vena cava obstruction.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Clinical photograph of patient showing facial, neck and upper limb oedema, with sparing of the lower limbs.
Figure 2
Figure 2
CT scan with intravenous contrast. Coronal section depicting large multinodular thyroid goitre (T), extending retrosternally and causing significant compression of IJVs bilaterally at the level of the thoracic inlet between the thyroid gland and the first rib (A). There is also compression of subclavian veins at the thoracic inlet by the medial end of the first rib (B). There is also tracheal deviation to the right and moderate bilateral pleural effusions. IJV, internal jugular vein.
Figure 3
Figure 3
CT scan with intravenous contrast. Axial section through the superior mediastinum depicting a large retrosternal multinodular thyroid goitre (T). There is bilateral compression of the IJVs between the first rib and thyroid gland (A). Corresponding subclavian vein dilation is also shown (B). The thyroid (T) is more enlarged on the left causing tracheal deviation to the right. IJV, internal jugular vein.
See this image and copyright information in PMC

References

    1. Grant JD, Lee JS, Lee EW et al. . Superior vena cava obstruction. Endovasc Today 2009;8:72–6.
    1. Tolle SW, Cartwright CA, Parthemore JG. Innominate vein obstruction caused by intrathoracic goiter. West J Med 1981;135:235–8. - PMC - PubMed
    1. McKellar DP, Verazin GT, Lim KM et al. . Superior vena cava syndrome and tracheal obstruction due to multinodular goiter. Head Neck 1994;16:72–4. 10.1002/hed.2880160114 - DOI - PubMed
    1. Promisloff RA, Pervall-Phillips GP. Superior vena cava syndrome caused by a benign retrosternal multinodular goiter. J Am Osteopath Assoc 1997;97:409–10. - PubMed
    1. Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med 2007;356:1862–9. 10.1056/NEJMcp067190 - DOI - PubMed

Publication types