The surgical management of substernal and intrathoracic goiter

Abstract

M UCH has been written on substernaI and intrathoracic goiter in recent years but the terminoIogy has been indefinite. They are not synonymous terms but more recently the Iiterature has been Iess confusing. If we are abIe to adhere strictIy to the term “intrathoracic goiter,” we must then consider onIy those within the thoracic cage as true intrathoracic goiters. Those that extend through the thoracic aperture are considered as partiaI intrathoracic goiters. However, in reviewing the Iiterature one notes that any goiterous tumor that extends into the thoracic cage and remains in that position even after coughing or swaIIowing or forced expiration is considered an intrathoracic goiter. If one adheres to this cIassification, the incidence of true intrathoracic goiter wiII be found to be Iess than I per cent. PartiaI intrathoracic goiter has a greater incidence, ranging from 25 to 30 per cent in the goiterous areas and IO to 15 per cent in non-goiterous areas. CriIe’ reported an incidence of Iess than I per cent and Hunt2 reported three cases of tota intrathoracic goiter in a series of 651 cases. Curtis3 reports the incidence of tota intrathoracic goiter as between I and 2 per cent. In a series of 4,006 cases at the Mayo Clinic reported by Pemberton4 0.6 per cent were intrathoracic and 13.5 per cent partia1 intrathoracic goiters. The ratio of intrathoracic goiter in male and femaIe remains the same, about one to five as any adenomatous goiter. The age incidence averages at about forty-five years. It is rareIy found beIow the age of twenty, but is not infrequent after sixtyfive. One of our oldest operative patients Resident in Surgery