July - September 2017, Volume 13, Issue 3

Nistor C, Ciuche A, Constantinescu I

Emergency Surgical Tracheal Decompression in a Huge Retrosternal Goiter

Acta Endo (Buc) 2017, 13 (3): 370-374
doi: 10.4183/aeb.2017.370

Introduction. Over the past decades, several definitions and classifications of cervico-mediastinal goiters have been proposed. We analyzed and discussed the clinical presentation, the diagnostic procedures and the surgical technique in relation to post-operative complications and long-term results in a case of a sixtysix years old obese, hypertensive female admitted in the Thoracic Surgery Department with respiratory distress (inspiratory dyspnea, stridor) progressively aggravating during the latest month. Methods. Cervico-thoracic CT scan revealed the existence of a cervico-mediastinal huge goiter which developed mostly intrathoracic (2/ 3 of the goiter). It determined a tracheal compression, reducing its caliber by two thirds, and its displacement to the right side. The proposed surgical procedure was total thyroidectomy and it involved a bipolar approach (transcervical and transsternal) through a partial upper cervico-sternotomy. Results. The complete removal of the goiter and the decompression of the trachea have been achieved. Postoperative results were very satisfactory, with the absence of the respiratory distress. The histological examination revealed a multinodular goiter with epithelium hyperplasia. Conclusion. The presence of a complicated cervico-mediastinal goiter with severe respiratory distress required a surgical excision as the main and immediate treatment option. The surgical procedure represented a milestone for both the anesthesiologist (difficult intubation, with a thin tracheal tube in the absence of the jet ventilation technology) and for the surgeon. The goiter’s excision from the visceral mediastinum was very difficult because of its huge dimensions and close relations with trachea and great vessels (anterior) and esophagus, erector spinal muscles and the spine (posterior).

Keywords: cervico-mediastinal, substernal, retrosternal, intrathoracic goiter, cervicosternotomy, total thyroidectomy

Correspondence: Claudiu Nistor MD, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., District 5, Bucharest, 050474, Romania, E-mail: claudiu.nistor58@gmail.com