A rare presternal goiter: presentation and literature review

Presternal goiters are incredibly rare presentations worldwide; very little is known about their genesis despite many hypotheses and even fewer cases are seen in our medical literature. The commonest pathology for presternal goiters is papillary carcinoma of the thyroid (PCT), typically presenting as a solitary cystic cervical mass. Differential diagnoses are vast causing diagnostic difficulty, prompting crucial pre-operative radiological investigations and pathological confirmation. Curative management in all cases of malignant presternal goiters is total thyroidectomy with a modified radical neck dissection where indicated. Post operative radioiodine ablation and suppressive thyroxine therapy are often used and serial thyroglobulin surveillance is done. Interestingly, this is the first documented case in which previous cardiac surgery with mediastinal scarring and deficiency in the deep cervical fascia maybe predisposing factors. Therefore, we propose two new theories in the causation of this rare phenomenon.