Intrathoracic (mediastinal) goiter. A clinical case

Abstract

Using a clinical case as the example the article sheds light on the issues of diagnosis and surgical treatment of intrathoracic goiter. A comprehensive approach to the problem which allows the most radical implementation of surgical treatment and involves thoracic and endocrine surgeons is taken into consideration. The intrathoracic goiter, which constitutes 16-37% of all cases of mediastinal tumors, can be removed by thoracic surgeons with the neck part of the thyroid gland left without surgical attention, which leads to reoperations. At the same time the intrathoracic part of the thyroid gland, occurring in 0.1-0.5% of cases among all the operated goiters, remains unnoticed by endocrine surgeons. In our case the diagnosis of intrathoracic goiter was proved in 56-year-old woman by the multispiral CT after the separated node of thyroid tissue was suspected by ultrasound examination and palpation. It was decided to carry out a joint operation. Under the conditions of the thoracic center the patient underwent cervicotomy, right-sided mid thoracotomy and extrafascial thyroidectomy. The neck part of the thyroid gland was removed with extrafascial standard exposure according to Kocher. The thoracic part was removed with thoracotomy exposure. If the multinodular goiter is localized in posterior mediastinum the transverse size of aperture should be considered for the choice of surgery tactic: in cases the latter is