Case Report: Cervical approach for dual mediastinal ectopic thyroid: clinical utility of 3D imaging in surgical...

We report an exceptionally rare case of synchronous dual ectopic thyroid tissue (ETT) located in both the anterior and posterior mediastinum of a 54-year-old woman presenting with a symptomatic multinodular goiter and early-stage primary hyperparathyroidism. Preoperative evaluation revealed significant tracheal compression and deviation. The patient underwent a combined procedure consisting of right subtotal thyroidectomy, left total thyroidectomy, and parathyroidectomy. While thoracoscopic resection was initially considered for the mediastinal masses, three-dimensional (3D) vascular reconstruction (VR-RENDER) revealed that the blood supply originated exclusively from cervical vessels, with no identifiable thoracic pedicles. This crucial finding enabled the safe extraction of both isolated mediastinal lesions via a single transcervical incision using blunt manual dissection, thereby obviating the need for sternotomy or thoracoscopy. The surgical outcome was excellent, with minimal blood loss (< 5 mL) and no postoperative complications. This case highlights the complex diagnostic and surgical challenges of multi-compartmental ETT and underscores the critical role of 3D imaging in optimizing preoperative planning and facilitating minimally invasive surgical approaches.