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Retrosternal goiter masquerading as type II respiratory failure. A case report
Sohail Bakkar1, Queen Hamdeh1, Robert Haddadin1
1Department of General and Specialized Surgery, Faculty of Medicine, the Hashemite University, Zarqa 13133, Jordan.
International Journal of Surgery Case Reports
|April 24, 2022
Summary
Retrosternal goiter (RG) can be challenging, but even with concerning anatomical features and prior surgery, a cervical approach may succeed. Experienced surgeons can often manage RG via cervical access, minimizing surgical and aesthetic risks.
Area of Science:
- Thoracic surgery
- Surgical oncology
- Endocrinology
Background:
- Retrosternal goiter (RG) presents surgical challenges, with most cases managed via cervical access.
- A subset of RGs necessitates extra-cervical approaches due to mass characteristics.
Purpose of the Study:
- To highlight the successful management of a complex retrosternal goiter case.
- To emphasize the role of surgical expertise in determining the approach for retrosternal goiter removal.
Main Methods:
- Case report of an 81-year-old female with retrosternal goiter presenting as respiratory failure.
- Preoperative imaging (CT scan) to assess anatomical features and mediastinal extension.
- Surgical intervention via a cervical approach despite indications for an extra-cervical route.
Main Results:
- The retrosternal goiter extended significantly into the mediastinum and posterior mediastinum.
- Despite anatomical factors favoring an extra-cervical approach, the cervical approach was successfully completed.
- The patient presented with type 2 respiratory failure and a history of subtotal thyroidectomy.
Conclusions:
- Computed tomography (CT) is crucial for assessing the need for an extra-cervical approach in retrosternal goiter.
- Experienced surgeons should attempt cervical access for retrosternal goiter, employing advanced techniques.
- Cervical approach offers reduced surgical and aesthetic risks compared to extra-cervical methods.
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