Mediastinal goitre – a South African case series

Abstract

Background: Mediastinal goitres are rare and may be diagnosed late since they are likely to manifest with non-specific cardiorespiratory  symptoms especially when there is no visible cervical component. The imaging modality of choice is a contrast-enhanced computed  tomography (CT) scan of the neck and chest after incidental finding of goitre on chest X-ray indicated for a condition unrelated to goitre.  

Method: This case series aims to highlight the peculiarity of mediastinal goitre in terms of clinical presentation, surgical approach, airway  challenges at anaesthesia, specific complications and final histopathological report.

Results: Over a nine-year period, four cases  of euthyroid mediastinal goitre underwent sternotomy. The mean age was 57.5 years (45–71) and all patients were female. Most patients  presented with non-specific cardiorespiratory symptoms. The difficult airway set was used in all cases and there were two instances of  damage to the recurrent laryngeal nerve (RLN). All histopathological reports were benign.

Conclusion: The presentation of the  mediastinal goitres was atypical. Cervical incision and sternotomy were performed in all cases. There were two instances of RLN injury  and no malignant histopathology. Despite the potential threat to the airway, all intubations were uneventful.