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11-29-2009, 09:42 AM
RETROSTERNAL GOITRE
Aetiology:
1- Retrosternal extension from M.N.G. in normally placed thyroid (rare).
2- Goitre in congenitally intrathoracic ectopic thyroid.
Incidence: common in males WHY ?
ˇ Short neck.
ˇ Strong pretracheal muscles which direct the swelling to the chest under the influence of gravity or negative intrathoracic pressure.
Types:
ˇ Substernal type:- Pass to sup. mediastinum (common).
ˇ Introthoracic type:- Pass to post. mediastinum (Rare).
Clinical Picture:
ˇ Closely simulate patient with heart failure. WHY? Because Compression on the trachea.
ˇ Dyspnea, cough espicially on lying down, the patient prefers to spend the night in chair.
ˇ Compression on the innominate vein Žengorged neck veins with congestion and oedema in the face.
ˇ Dysphagia and hoarseness of voice may occur.
Differential Diagnosis:
1- Heart failure. 2- Other causes of mediastinal syndrome.
Diagnosis:
Palpation : Enlarged thyroid lower border not felt.
Percussion: Dullness over the sternum is rarely elicited.
Plain X- ray chest: Opacity in the mediastinum. Lateral view can detect its site.
Radioactive isotope scanning.
Treatment: Subtotal thyroidectomy usually through low collar incision. As its blood supply coming from the neck Rarely sup. mediastinotomy is needed with cases having independent blood supply.
SOURCE: Prof. AYMAN SALEM'S BOOK
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