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
. 2022 May:94:107104.
doi: 10.1016/j.ijscr.2022.107104. Epub 2022 Apr 20.

Retrosternal goiter masquerading as type II respiratory failure. A case report

Sohail Bakkar  1 , Queen Hamdeh  2 , Robert Haddadin  2 , Gianluca Donatini  3 , Theodosios S Papavramidis  4 , Mohamed Tawalbeh  5
Affiliations

Retrosternal goiter masquerading as type II respiratory failure. A case report

Sohail Bakkar et al. Int J Surg Case Rep. 2022 May.

Abstract

Introduction and importance: Retrosternal Goiter (RG) represents a challenging clinical entity for surgeons. Although the vast majority of cases are successfully operated via a cervical access, there still remains a small minority that require an extra-cervical approach, even in experienced hands. Factors that shift the odds towards an extra-cervical approach are mainly related to the anatomic characteristics of the retrosternal mass.

Case presentation: We herein report a case of RG presenting as type 2 respiratory failure without a palpable neck mass, in an 81-year-old female. Despite her history of subtotal thyroidectomy for Graves' disease, the patient's chest x-ray showed a central mediastinal mass shifting the trachea to the left. The retrosternal mass extended below the aortic arch, and carina on computed tomography. It also extended into the posterior mediastinum. All these anatomical features of the RG along with the patient's previous neck surgery were in favor of an extra-cervical approach. Nevertheless, a cervical approach was attempted, and was concluded successfully.

Conclusion: CT plays a key role in determining the likelihood of requiring an extra-cervical approach in RG. Even if the odds seem to be in favor of an extra-cervical approach, an attempt to remove the goiter through a cervical incision should always be made by an experienced surgeon, using all available techniques, and taking all required precautions, on account of less risk of surgical and aesthetic damage obtained with this approach.

Keywords: Goiter; Intrathoracic; Mediastinal; Retrosternal.

PubMed Disclaimer

Conflict of interest statement

All authors have completed the disclosure form for IJS Case Reports, and have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Chest x-ray demonstrating a widened mediastinum with tracheal deviation to the left.
Fig. 2
Fig. 2
(A) Coronal view: extension below the carina (B) Sagittal view: extension into the posterior mediastinum (C) Axial view: extension below the aortic arch.
Fig. 3
Fig. 3
(A) Lateral view of the resected right thyroid lobe with its cervical and retrosternal components. (B) Superior view of the surgical specimen.
Fig. 4
Fig. 4
Post-operative chest x-ray with a centrally located trachea and no mediastinal mass.
Fig. 5
Fig. 5
The patient one-week post-surgery with a cosmetically favorable result. This image is published with the patient's consent.
See this image and copyright information in PMC

References

    1. Agha R.A., Franchi T., Sohrabi C., Mathew G., for the SCARE Group The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int. J. Surg. 2020;84:226–230. - PubMed
    1. Eng P., Cardona G., Fang S.L., Previti M., Alex S., Carrasco N., Chin W., Braverman L. Escape from the acute wolff-chaikoff effect is associated with a decrease in thyroid Sodium/Iodide symporter messenger ribonucleic acid and protein. Endocrinology. 1999;140:3404–3410. doi: 10.1210/endo.140.8.6893. - DOI - PubMed
    1. Bakkar S., Papavramidis T.S., Aljarrah Q., Materazzi G., Miccoli P. Energy-based devices in thyroid surgery—an overview. Gland Surg. 2019 doi: 10.21037/gs.2019.08.05. - DOI - PMC - PubMed
    1. Singh I.D., Gupta V., Raina S., Goyal S., Kumar M. Large retrosternal goiter: an otolaryngological perspective-case series and review of literature. J. Otolaryngol. ENT. Res. 2017;6:00147. doi: 10.15406/joentr.2017.06.00147. - DOI
    1. Kesici U., Koral Ö., Karyağar S., Kesici S., Yılbaş A., Karyağar S., Mataracı E., Mataracı İ. Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter. Ulus Cerrahi Derg. 2015;32:67–70. doi: 10.5152/UCD.2015.2916. - DOI - PMC - PubMed