A middle aged lady with midline neck swelling went to a local hospital for evaluation of recent onset dyspnea. Clinical examination revealed thyromegaly. She was referred to a higher centre for further evaluation. Ultrasound neck revealed a picture of multinodular goitre with the lower pole of left lobe not being visualized. Since there was significant dyspnea, she was advised surgical removal. The surgeon ordered a pre operative CT Neck to assess the retrosternal extension of the goitre.
Non enhanced CT neck
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CT Neck revealed a goitrous left lobe 9cm in its greatest dimension (craniocaudal) extending posterior to the great vessels, 3.4cm below the top of the manubrium. The tracheal axis is shifted to the right and about 2cm below the cricoid cartilage, the trachea is compresssed for a length of 5cm, causing approx. 40% tracheal lumen cross sectional narrowing.
The importance in reporting the inferior extension of a goiter lies in the surgical management that differs for a substernal vs mediastinal goiter
The following should be reported by the radiologist
- craniocaudal extent with reference to surgically identifiable landmarks
- course in relation to great vessels
- length and extent of tracheal compression
- displacement/involvement of neck vessels
The final impression of a mediastinal goiter was given in this case.
- Pollard DB, Weber CW, Hudgins PA. Preoperative imaging of thyroid goiter: how imaging technique can influence anatomic appearance and create a potential for inaccurate interpretation. AJNR Am J Neuroradiol. 2005;26 (5): 1215-7.Pubmed citation