Patient-tailored management of an asymptomatic massive substernal goiter presenting as brachiocephalic vein occlusion. Report of a case and review of sternotomy indications

Sahsamanis, Georgios; Chouliaras, Eleftherios; Katis, Konstantinos; Daliakopoulos, Stavros I; Dimitrakopoulos, Georgios

doi:10.1016/j.ijscr.2017.01.003

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Diagnosis of substernal goiter is mainly dependent on imaging techniques. Chest radiograph may indicate tracheal displacement and may successfully imply the presence of a substernal goiter, but computed tomography (CT) scan is of vital importance for the preoperative assessment of the position of the goiter and its extension in the thoracic cavity [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Arrest Caused by Large Substernal Goiter—Treatment with Combined Cervical Approach and Median Mini-Sternotomy: Report of a Case

et al. 2021

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Introduction: Substernal goiter is usually defined as a goiter that extends below the thoracic inlet or a goiter with more than 50% of its mass lying below the thoracic inlet. Substernal goiters may compress adjacent anatomical structures causing a variety of symptoms. Case report: Here we report a rare case of a 75-year-old woman presenting with cardiac arrest caused by acute respiratory failure due to tracheal compression by a substernal goiter. Discussion: Substernal goiters can be classified as primary or secondary depending on their site of origin. Symptoms are diverse and include a palpable neck mass, mild dyspnea to asphyxia, dysphagia, dysphonia, and superior vena cava syndrome. Diagnosis of substernal goiter is largely based on computed tomography imaging, which will show the location of the goiter and its extension in the thoracic cavity. Surgery is the treatment of choice for symptomatic patients with substernal goiter. The majority of substernal goiters are resected through a cervical approach. However, in approximately 5% of patients, a thoracic approach is required. The most important factor determining whether a thoracic approach should be used is the depth of the extension to the tracheal bifurcation on CT imaging. Conclusion: Cardiac arrest appearing as the first symptom of a substernal goiter is a very rare condition and should be treated by emergency thyroidectomy via a cervical or thoracic approach depending on the CT imaging findings.

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Arrest Caused by Large Substernal Goiter—Treatment with Combined Cervical Approach and Median Mini-Sternotomy: Report of a Case

et al. 2021

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Substernal goitre presenting with upper and lower extremity oedema

et al. 2021

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Substernal goitre is characterised by compressive symptoms of the airway and oesophagus. Chronic, progressive symptoms usually result in surgical removal. We report a rare presentation of substernal goitre in a male in his early 70s who suffered from severe bilateral lower extremity (LE) lymphoedema, resulting in immobility and nursing home placement, and left upper extremity lymphoedema. Our initial assessment led to a filariasis work-up, which was negative, due to the patient’s prior 2-year residence in India and service overseas. Chest CT scan revealed an incidental substernal goitre extending posterior to the left innominate vein and aortic arch to the level of the left mainstem bronchus. The patient underwent a left hemithyroidectomy via cervical excision and sternotomy and had an uneventful recovery with resolution of lymphoedema and mobility. Despite extensive literature regarding clinical presentations of substernal goitre, severe lymphoedema of the LE is not a well-established association.

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Clinical Presentation and Surgical Treatment of Retrosternal Goiter: A Case Series Study

Abdelrahman

Al-Thani

Al-Sulaiti

et al. 2020

Qatar Medical Journal

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Background: The retrosternal goiter (RSG) is a slow-growing mass often benign in nature; thyroidectomy remains the preferred standard curative treatment. This study aimed to explore the local experience of RSG with respect to the clinical presentation, classifications, management, and outcomes. Method: A retrospective chart review was conducted to include all cases diagnosed with RSG and underwent thyroidectomy between January 1998 and December 2013. Results: A total of 1210 patients underwent thyroidectomy; of which 30 (2.5%) patients were diagnosed to have RSG. The commonly reported symptoms were dyspnea (40%), pain and discomfort (30%), dysphagia (26.7%), and hoarseness (20%). Thirteen patients (43.3%) were completely asymptomatic. The fine-needle aspiration cytology was performed in 22 (73.3%) patients, of whom the majority was benign (77.3%). The grading classification showed that grade 1 is the most frequent (73.3%). Total bilateral thyroidectomy was the most prevailing procedure in 57% cases followed by partial thyroidectomy. All patients underwent retrosternal thyroidectomy through a cervical incision except for one case. Postoperative histopathology showed frequent benign multinodular goiter (83.3%), followed by papillary thyroid cancer (10%) and thyroiditis (6.7%). The most common complication after thyroidectomy was tracheomalacia (13.4%), transient hypocalcemia (10%), and hypoparathyroidism (6.7%). There was no intraoperative or perioperative mortality. Conclusion: RSG is a rare entity often presented with pressure symptoms, mostly involving anterior mediastinum and had a challenging surgical procedure. A large multicenter study is needed to include more cases in order to have a consensus on the definition and classification system for such important clinical goiter presentation.

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Patient-tailored management of an asymptomatic massive substernal goiter presenting as brachiocephalic vein occlusion. Report of a case and review of sternotomy indications

Cited by 3 publications

References 9 publications

Cardiopulmonary Arrest Caused by Large Substernal Goiter—Treatment with Combined Cervical Approach and Median Mini-Sternotomy: Report of a Case

Cardiopulmonary Arrest Caused by Large Substernal Goiter—Treatment with Combined Cervical Approach and Median Mini-Sternotomy: Report of a Case

Substernal goitre presenting with upper and lower extremity oedema

Clinical Presentation and Surgical Treatment of Retrosternal Goiter: A Case Series Study

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