Posterior Mediastinal Goiter Research Articles

A Giant Posterior Mediastinal Goiter

Goiter is defined as abnormal (either nodular or diffuse) growth of the thyroid gland. The normal thyroid gland is located in neck, caudal to larynx in anterolateral portion of the trachea. Intrathoracic goiter, defined as growth of more than 50% of the thyroid gland below the thoracic operculum, mostly located in anterior mediastinum and is seen in only 8%–15% of all goiters. Posterior mediastinal goiters (PMGs) are rare and accounts for only 2% of intrathoracic goiters. Patients usually present with a cervical mass and local pressure symptoms due to tracheal, esophageal, or superior vena cava compression. The diagnosis is established by chest X-ray, computed tomography scan, and fine-needle aspiration cytology. A combined cervicothoracic approach is the procedure of choice as it provides easy access, better visualization, and optimal control of blood vessels. We, hereby, describe a case of giant PMG, which was managed successfully at our center.

Large posterior mediastinal goiter post total cervical thyroidectomy: a case report

Thoracotomy approach is indicated for a complete and safe posterior mediastinal goitre removal. A 68 years old male was hospitalized due to a right mediastinal mass found in a chest X-ray and confirmed by computed tomography. The patient had undergone total cervical thyroidectomy thirty years ago. A computed tomography (CT) guided percutaneous needle biopsy of the mass revealed thyroid tissue. Subsequently, the mass was completely resected through a right posterolateral thoracotomy. The histopathology confirmed a large mediastinal goitre with no signs of malignancy. The patient had an uncomplicated recovery. We present a relatively rare case of a successful resection of a posterior mediastinal goitre, occurring thirty years post-total cervical thyroidectomy. We advocate lateral thoracotomy to achieve a broad operative field and enhance surgical safety.

Giant posterior mediastinal goiter

Vast majority of mediastinal goiters are situated in the anterior mediastinal compartment and rarely located in the posterior mediastinum. Posterior mediastinal goiters should be differentiated from other mediastinal masses through appropriate work-up by the computed tomography which is the most valuable technique. We reported a case of symptomatic mediastinal goiter extending from the neck to the posterior mediastinum compressing the trachea and airway. The surgical intervention is considered the treatment of choice in such cases. The surgical approach was done through a classical transverse cervical incision, lateral right thoracotomy, and median sternotomy. The histopathological report was consistent with a multinodular goiter. The patient's recovery was uneventful with an excellent postoperative symptomatic relief.

Surgical Treatment of Substernal Goiters Extending to Posterior Mediastinum

Aim The purpose of this study was to identify the clinical features of posterior mediastinal goiters and surgical treatment strategies on the basis of our experiences. Methods Clinical data of 23 cases of posterior mediastinal goiters in 122 substernal goiters from a total of 4381 thyroidectomies performed in the Division of Thyroid Surgery of the General Surgery Department of Xiangya Hospital, Central South University, China, during a 6-year period (2010–2016) were analyzed. Results Posterior mediastinal goiters have a greater prevalence of compression symptoms compared with anterior mediastinal goiters (P < 0.05). Substernal goiters that extend to posterior mediastinum have a higher probability of mass bottom below the aortic arch than those extending to anterior mediastinum (P < 0.05). A total of 20 posterior mediastinal goiters (87.0%) underwent thyroidectomies by cervical approach without additional incision. In 3 of the 23 patients (13.0%), 1 thoracotomy and 2 thoracoscopic approaches were performed for a complete and safe removal. Postoperative complications occurred in 5 of 23 patients (21.7%), including temporary recurrent laryngeal nerve paralysis and transient hypoparathyroidism in our series. Conclusions Surgical removal of posterior mediastinal goiters can be performed safely by a single cervical approach in most patients. Thoracoscopic approach proposes a new treatment strategy with feasibility.

Complete transthoracic resection of giant posterior mediastinal goiter: A case report and review of the surgical approaches

Abstract Intrathoracic goiter (IG) is commonly located in the anterior mediastinum. Here, we report the case of a 54-year-old Chinese woman with successful removal of an intrathoracic goiter and improvement of dyspnea by a right posterolateral thoracotomy approach. Conclusion: Posterior mediastinal thyroid goiter with mediastinal compressive symptoms is an indication for surgery.

Massive Posterior Mediastinal Goiter Managed by ranscervical and Right Uniportal (Single Incision) Approach

The present case is of a 55-year-old female who underwent right hemi-thyroidectomy for a benign multinodular goiter 19 years before. Computed tomography showed the presence of a large posterior mediastinal mass which extended from the neck to the level of the right main bronchus adherent to the boyden branch of the right pulmonary artery. The patient underwent thyroidectomy through cervicotomy and right uniportal anterolateral thoracotomy. The mass was dissected free and then successfully removed. The patient was discharged 12 days post-operatively. There were no signs of recurrence at 6-year follow-up.

Bocio del mediastino posterior - abordaje mínimamente invasivo: videotoracoscopia derecha más cervicotomía

Surgery is the recommended treatment for intrathoracic goiter. About 90 % of the lessons can be resected by cervicotomy. The posterior mediastinal goiter was been successfully managed using different cervico-thoracic approaches; however, there is little available information in the literature about the use of videothoracoscopy as part of these combined techniques. We present a case of a patient with a intrathoracic goiter extended to the posterior mediastinum, in which, given the characteristics of the mass and its location added to the widely known benefits of minimally invasive surgery, it was decided to replace thoracotomy and sternotomy with videothoracoscopy allowing good exposure and safe dissection of the mediastinum. We consider that videothoracoscopy is a safe and effective technique in selected cases of patients with goiter extending into the posterior mediastinum.

Feasibility of thoracoscopic approach for retrosternal goitre (posterior mediastinal goitre): Personal experiences of 11 cases.

INTRODUCTION:Posterior mediastinal goitres constitute of a unique surgical thyroid disorder that requires expert management. Occasionally, they require thoracic approach for the completion of thyroidectomy. In this paper, we describe the feasibility and utility of a novel thoracoscopic approach for such goitres.MATERIALS AND METHODS:This is a retrospective study conducted at a tertiary care endocrine surgery department in South India over a period of 5 years from January 2010 to December 2014. We developed a novel thoracoscopic technique for posterior mediastinal goitres instead of a more morbid thoracotomy or sternotomy. All the clinical, investigative, operative, pathological and follow-up data were collected from our prospectively filled database. Statistical analysis was done with SPSS 15.0 version. Descriptive analysis was done.OPERATIVE TECHNIQUE OF THORACOSCOPIC THYROIDECTOMY:Single lumen endotracheal tube (SLETT) was used of anaesthetic intubation and general inhalational anaesthesia. Operative decubitus was supine with extension and abduction of the ipsilateral arm. Access to mediastinum was obtained by two working ports in the third and fifth intercostal spaces. Mediastinal extension was dissected thoracoscopically and delivered cervically.RESULTS:Out of 1,446 surgical goitres operated during the study period, 72 (5%) had retrosternal goitre. Also, 27/72 (37.5%) cases had posterior mediastinal extension (PME), out of which 11 cases required thoracic approach. We utilised thoracoscopic technique for these 11 cases. The post-operative course was uneventful with no major morbidity. There was one case of recurrent laryngeal nerve (RLN) injury and hoarseness of voice in the third case. Histopathologies in 10 cases were benign, out of which two had subclinical hyperthyroidism. One case had multifocal papillary microcarcinoma.CONCLUSIONS:We opine that novel thoracoscopic technique is a feasibly optimal approach for posterior mediastinal goitre, especially for benign and non-invasive malignant goitres.

Primary Mediastinal Goiter Resected via Cervical Approach

Primary mediastinal goiter is a rare entity. In most cases their finding is incidental. Excision is mandatory because of the risk of compression of vital structures within the chest. We report the case of a primary posterior mediastinal goiter that was resected through a cervical approach. being discharged she received a thoracic surgery consultation for tumor resection. Two months after discharge she was hospitalized again for surgery. A cervical surgical approach with the intention to convert to thoracotomy was planned. Through a standard collar incision, digital exploration and tumor dissection was made that properly surround it in its entirety surface with no evidence of adherences to any intrathoracic structure. The goiter had its blood supply from a branch of esophageal arteries at its cranial edge, which was identified and ligated. The surgical specimen was then removed with a clamp getting scarce bleeding at the surgical bed. Hemostasis was verified leaving a closed drainage that was later withdrawn. The cervical thyroid gland was explored during surgery with no abnormalities found. There were no intraoperative or postoperative complications and the patient was discharged from the hospital three days after surgery. Macroscopically, a tumor of 10 × 5 × 2 cm, with a multi-nodular surface, covered by a thin, translucent full capsule, with reddish brown and yellowish areas was reported (Figure 3a). Its interior was multi- nodular, composed by light brown areas of granular consistency, hemorrhagic areas and yellowish colloid-appearance areas. Indurated consistency areas were not identified. Microscopically (Figure 3b), small follicles of thyroid tissue with no colloid plus dilated cysts with abundant colloid were identified. Foamy macrophages, some with hemosiderin in their cytoplasm were also reported. There were no findings suggestive of malignancy. Dysphagia and cough disappeared after surgery and the patient remained asymptomatic after 19 months of follow-up. Discussion PMG, also known as aberrant goiter or ectopic mediastinal goiter implies the presence of intra-thoracic thyroid tissue independent of the cervical thyroid gland; its vascular supply comes from intra- thoracic vessels and is considered a benign entity. It's localized primarily in the anterior mediastinum (85% of cases). The middle and posterior mediastinum are less frequent locations in 15% of cases (4). It is a rare condition. Due to thyroid gland migration during embryonic development (between the 3rd and the 8th weeks) the location of primary ectopic goiter may occur from the tongue

Complete excision of a giant thyroid goiter in posterior mediastinum

Intrathoracic goiter is commonly located in the anterior mediastinum. Here we report a case of a 58-year-old Chinese male in whom we successfully removed the intrathoracic goiter and eased his dyspnea by a right posterolateral thoracotomy approach. Posterior mediastinal thyroid goiter with mediastinal compressive symptoms is an indication of surgery.

Retrosternal goiter located in the mediastinum: surgical approach and operative difficulties

Most retrosternal goiters are situated in the anterior mediastinal compartment, but according to the literature, 10-15% are located in the posterior mediastinum. Although most of the anterior mediastinal goiters can be removed by a transcervical approach, posterior mediastinal goiters may require additional extracervical incisions. We report the case of a huge posterior mediastinal goiter extending from the neck retrotracheally beyond the aortic arch and azygous vein with crossover from the left to the right side and ending at the level of the lower part of the left cardiac atrium, nearly reaching the diaphragm. Surgical removal is the treatment of choice in such cases. We performed an operation using a transcervical and right thoracotomy approach. Histopathological examination confirmed the diagnosis of the large goiter. The patient recovered well and was discharged in 1 week.

Extraction of substernal goitre using an innovative vacuum device

The extraction by cervicotomy of substernal goitres may be impossible and sometimes requires the enlargement of the thoracic inlet with at least a sternal-split. We present the extraction of a posterior mediastinal substernal goitre with the application of an innovative vacuum-based suction device, previously used for the control of bleeding from the heart and great vessels in clinical and experimental conditions.

Posterior mediastinal goiters: Report of two cases and literature review

Intrathoracic goiters represent substantial enlargement and descent of cervical thyroid tissue into the thoracic cavity, usually in the anterior mediastinum. Rarely, they extend posteriorly, causing obstructive symptoms, sometimes with acute onset. Posterior mediastinal goiters should be differentiated from other mediastinal masses by appropriate work-up, while computed tomography is the most valuable technique. We report two cases of such symptomatic goiters. First reported case was atypically presented with aspiration pneumonia and second was successfully operated. Our overview aims to increase awareness of this rare clinical entity due to possible respiratory compromise. Reasonable surgical management is mandatory.

A Novel Approach of Videothoracoscopic Surgery for Posterior Mediastinal Goiter

ABSTRACT Intrathoracic extension of large goiters occasionally requires thoracic approaches, such as sternotomy, anterior or posterolateral thoracotomy. Videothoracoscopic technique is a minimally invasive approach, but usually done under single lung ventilation with double lumen endotracheal tube anesthesia. But, this newer technique of thoracoscopic dissection and delivery of posterior mediastinal goiter with partial lung collapse minimizes the postoperative morbidity and pulmonary complications. How to cite this article Bhargav PRK, Uday SK, Amar V. A Novel Approach of Videothoracoscopic Surgery for Posterior Mediastinal Goiter. World J Endoc Surg 2012;4(2):83-84.

Large posterior mediastinal retrosternal goiter managed by a transcervical and lateral thoracotomy approach

Most retrosternal goiters are situated in the anterior mediastinal compartment. Posterior mediastinal goiters are uncommon, comprising 10%-15% of all mediastinal goiters. Although most of the anterior mediastinal goiters can be removed by a transcervical approach, posterior mediastinal goiters may require additional extracervical incisions. We report the case of a large posterior mediastinal goiter extending retrotracheally beyond the aortic arch and azygous vein with crossover from the left to the right side. It was excised using a transcervical and right thoracotomy approach. The literature is reviewed to clarify the management of retrosternal goiters with regard to the various approaches, indications for extracervical incisions, and their complications. In conclusion, whereas most retrosternal goiters can be resected through a transcervical approach, those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy. The overall number of complications associated with this approach, however, is higher than that seen with the transcervical approach.

An Unusual Recurrent Intrathoracic Goiter: Case Report

Most intrathoracic goiters are located in the anterior mediastinum, frontal to the recurrent laryngeal nerve and anterolateral to the trachea. Posterior mediastinal goiters account for only 10 to 15% of all intrathoracic goiters and arise from the posterolateral portion of the thyroid gland. We present a case involving a 59-year-old man with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. He had undergone bilateral thyroid lobectomy for a cervical goiter 10 years previously, with no subsequent complications. Contrast-enhanced computed tomography demonstrated a large, well-circumscribed mass extending paratracheally from the thoracic inlet to the posterior mediastinum. The mass was removed via a transcervical and transthoracic approach.

Diagnosis of a posterior mediastinal goitreviaendobronchial ultrasound-guided transbronchial needle aspiration

To the Editors : Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a rapidly developing diagnostic tool. Its utility as a minimally invasive and safe procedure in mediastinal node staging in lung cancer is defined and gaining widespread acceptance. The role of this procedure in the diagnosis of benign diseases is less clear. We report the first case of a posterior mediastinal intrathoracic goitre diagnosed with the aid of EBUS-TBNA. A 46-yr-old female was referred to the outpatient chest clinic for further investigation of a superior mediastinal mass. She complained of a 4-month history of progressive shortness of breath on exertion. She denied any dysphagia. Examination was unremarkable. A chest radiograph showed a right superior mediastinal mass. Her thyroid function tests were within normal limits. Contrast-enhanced thoracic computed tomography revealed a large posterior mediastinal mass, containing areas of punctate calcification (fig. 1⇓). There was no associated mediastinal adenopathy and the lung parenchyma was normal. Histological confirmation was considered necessary to the planning of surgical …

A Novel Robot-Assisted Technique for Excision of a Posterior Mediastinal Thyroid Goiter

: Intrathoracic thyroid goiter is an uncommon condition. Most goiters are found in the superior and anterior mediastinum, which can be removed either through a cervical approach or through a combined cervicotomy and sternotomy approach. Extension of the goiter into the posterior mediastinum is even less common. Transcervival approach to thyroid goiters in the posterior mediastinum can be difficult, necessitating a thoracotomy, with its associated morbidity. : A 69-year-old patient underwent robotic assisted minimally invasive procedure, with the daVinci surgical robotic system to excise a thyroid goiter that extended into the posterior mediastinum. The blood supply of the mediastinal portion of the goiter originated from the right internal thoracic artery. The thoracic and mediastinal portion of the goiter was approached with robot-assisted minimally invasive surgical techniques. Small incisions were used to gain access to the posterior mediastinum via the right pleural cavity, obviating the need for thoracotomy. Using precise movements of the robotic arm, the mediastinal part of the goiter was dissected off vital structures, from within the posterior mediastinum. Total thyroidectomy was then completed using the cervical approach. : The patient tolerated the procedure well, with minimal intraoperative blood loss. The patient was discharged home after a short hospital stay. : Robotic surgical techniques for removal of a substernal goiter and other thyroid masses with mediastinal extension, in combination with cervical incision, are effective. Robotic-assisted techniques can complement video-assisted thoracic surgical techniques and broaden the indications for minimally invasive surgery.

A Novel Robot-Assisted Technique for Excision of a Posterior Mediastinal Thyroid Goiter

A Novel Robot-Assisted Technique for Excision of a Posterior Mediastinal Thyroid Goiter

Novel thoracoscopic approach to posterior mediastinal goiters: report of two cases

Trans-cervical resection of posterior mediastinal goiters is usually very difficult, requiring a high thoracotomy. Until recently, using conventional video-assisted thoracoscopic surgery to resect such tumors has been technically difficult and unsafe. By virtue of 3 dimensional visualization, greater dexterity, and more accurate dissection, the Da Vinci robot, for the first time, enables a completely minimally invasive approach to the posterior superior mediastinum.