Novel technique for control of mediastinal bleeding during thyroidectomy for substernal goiter.

Abstract

Goiters are estimated to develop in approximately 5% of the population. By definition, for a goiter to be considered mediastinal, at least 50% of the thyroid tissue must be located substernally. Mediastinal goiters can, in turn, be classified as primary or secondary. Primary mediastinal goiters, which represent about 1% of all mediastinal goiters, arise from accessory (ectopic) thyroid parenchyma located in the chest. These goiters are mainly intrathoracic and do not have any connection to thyroid tissue in the neck. Their blood supply originates from intrathoracic vessels. Secondary mediastinal goiters constitute the majority of mediastinal goiters and arise from downward extension of cervical thyroid tissue along the fascial planes of the neck. These goiters derive their blood supply from the superior and inferior thyroid arteries. This migration along the path of least resistance is assisted by negative mediastinal pressure generated by inspiration and swallowing. Most mediastinal goiters can be removed via a cervical incision, but patients with recurrent goiters can require a median sternotomy because of the development of parasitic mediastinal vessels. In this article, we present the case of a patient with a secondary mediastinal goiter who developed bleeding after its removal via a cervical incision, and report on the use of a Foley catheter to control the same.