Endothoracic goiter with retro tracheal and pre esophageal

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Endothoracic goiter with retro tracheal and pre esophageal Powered By Docstoc
					                                                                   Coup d’œil               Schweiz Med Wochenschr 1999;129:386

N. Halkic, R. Ksontini, M. Boumghar                            Endothoracic goiter with
Service de chirurgie,                                          retro-tracheal and pre-esophageal
Lausannne                                                      migration

                               Endothoracic goiter is a rare clinical entity.               goiters can be removed through a cervical
                               This goiter can develop slowly and the patient               incision; however, a median sternotomy or
                               may be asymptomatic for many years. A signi-                 postero-lateral thoracotomy may be required
                               ficant number of these patients, however, may                in 1 to 2% of patients.
                               develop various complications as a result of                 A 73-year-old female presented to her physi-
                               compression of vital structures or malignancy.               cian with a history of swallowing difficulties.
                               Airway obstruction, which poses a life-threat-               She had no signs of hypo- or hyperthyroidism.
                               ening situation, may be suddenly precipitated                Chest X-ray and aortogram showed a large
                               by spontaneous or trauma-induced bleeding                    mass originating from the superior mediasti-
                               into the goiter. Endothoracic goiters are known              num and vascularized by the inferior thyroid
                               to have a relatively high incidence of malig-                artery (fig. 1). The aortogram was obtained to
                               nancy. Advances in anaesthetic techniques and                rule out an aortic lesion. The patient under-
                               the use of small-caliber endotracheal tubes                  went a right thoracotomy and cervicotomy. An
                               facilitate proper perioperative management,                  endothoracic, multinodular goiter that had mi-
                               even for patients with significant respiratory               grated between the trachea and the esophagus
                               compression symptoms. Most endothoracic                      was removed (fig. 2).

Figure 1                                                                         Figure 2

                                                                                            Dr. Nermin Halkic,
Unter der Rubrik «Coup d’œil» publiziert die Schweizerische Medizinische Wochenschrift
Augenfälliges aus dem gesamten Bereich der Medizin. Bilder, Graphiken und Darstellungen     Service de chirurgie,
von allgemeinem Interesse können unter Angabe von Titel, Autor und kurzem Begleittext       CHUV, CH-1011 Lausanne
beim Verlag eingereicht werden.                                                             e-mail: Nermin.Halkic@chuv.hospvd.ch


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