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Radiology Image: A 54-year-old female

A 54-year-old female

[headline_subtitle title=”” subtitle=”Can you solve the radiology image of this edition?”]
Patient data
  • Age: 54
  • Gender: Female
  • Native country: Ghana
  • Medical history: Graves’ disease, smoking and hypertension
  • Family history: Cardiovascular diseases
  • Initial presentation: Coughing, shortness of breath and no fever.
  • Examination: Normal auscultation and normal percusion



[WpProQuiz 6]




[WpProQuiz 7]

S. Spijkers & M. Maas

Checklist Röntgen (Thorax)

  1. Mediastinum: should be symmetric and biconcave.
  2. Trachea: should be in the center of the mediastinum.
  3. Hilum: evaluate lymph nodes.
  4. Heart: heart-thorax ratio should be ≤0.5 (during full inspiration).
  5. Vessels: should be narrow and taper towards periphery.
  6. Lung fields: check for infiltrates + evaluate sinus pleurae for pleural effusion, and periphery of upper lung fields for pneumothorax.
  7. Diaphragm: should be easily distinguishable.
  8. Bones: ribs, sternum, clavicles, scapulae, vertebrae.
  9. Soft tissues: check for foreign bodies.

PS: first check for anterolateral straightness and proper inspirational position

Checklist CT (Thorax)

  1. Soft tissues, especially:
    1. Axillary lumph nodes
  2. Mediastinum in four regions:
    1. From the aortic arch cranially (lymph nodes?, thymoma/struma?)
    2. Hilar region (configuration and size of vessels, lobulated and enlarged?)
    3. Heart and coronary arteries (calcium deposits?)
    4. Four typical sites of predilection for lymph nodes:
      1. Anterior to aortic arch (normal: almost none or < 6 mm)
      2. In the aortopulmonary window (normal: <4 lymph nodes <15 mm)
      3. Subcarinal (normal: <10 mm)
      4. Next to descending aorta (normal: <10 mm; do not confuse with azygos vein)
  3. Parenchyma of the lung:
    1. Normal branching pattern and caliber of vessels?
    2. Vascular oligemia only at interlobar fissures? Bullae?
    3. Any suspicious lung foci? Inflammatory infiltrates?
  4. Pleura:
    1. Plaques, calcification, pleural fluid, pneumothorax?
  5. Bones (vertebrae, scapula, ribs):
    1. Normal structure of marrow?
    2. Degenerative abnomalities?
    3. Focal lytic or sclerotic processes?
    4. Stenoses of the spinal canal?

The currently accepted definition of an intrathoracic goitre is a thyroid gland with more than 50% of its mass located below the thoracic inlet.This term can be further classified as an “incomplete” or a “complete” intrathoracic goitre. When the goitre is “incomplete,” a major portion of the goitre in the neck is visible, with its lower pole being substernal, subclavicular or intrathoracic. Conversely, a “complete” or “true” intrathoracic goitre is one that is completely within the mediastinum and separate from a coexisting cervical thyroid gland.Thus, the uppermost part is barely palpable in the sternal notch.Most intrathoracic goitres can be removed safely through a cervical incision.More invasive sternotomy can be performed for complicated cases in which the goitre cannot be removed by any other procedure.


  1. Can J Surg. Oct 2008; 51(5): E111–E112. PMCID: PMC2556542Management of intrathoracic goitre, Pia Pace-Asciak* and Kevin Higgins†

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