- 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
S. Spijkers & M. Maas
Checklist Röntgen (Thorax)
- Mediastinum: should be symmetric and biconcave.
- Trachea: should be in the center of the mediastinum.
- Hilum: evaluate lymph nodes.
- Heart: heart-thorax ratio should be ≤0.5 (during full inspiration).
- Vessels: should be narrow and taper towards periphery.
- Lung fields: check for infiltrates + evaluate sinus pleurae for pleural effusion, and periphery of upper lung fields for pneumothorax.
- Diaphragm: should be easily distinguishable.
- Bones: ribs, sternum, clavicles, scapulae, vertebrae.
- Soft tissues: check for foreign bodies.
PS: first check for anterolateral straightness and proper inspirational position
Checklist CT (Thorax)
- Soft tissues, especially:
- Axillary lumph nodes
- Mediastinum in four regions:
- From the aortic arch cranially (lymph nodes?, thymoma/struma?)
- Hilar region (configuration and size of vessels, lobulated and enlarged?)
- Heart and coronary arteries (calcium deposits?)
- Four typical sites of predilection for lymph nodes:
- Anterior to aortic arch (normal: almost none or < 6 mm)
- In the aortopulmonary window (normal: <4 lymph nodes <15 mm)
- Subcarinal (normal: <10 mm)
- Next to descending aorta (normal: <10 mm; do not confuse with azygos vein)
- Parenchyma of the lung:
- Normal branching pattern and caliber of vessels?
- Vascular oligemia only at interlobar fissures? Bullae?
- Any suspicious lung foci? Inflammatory infiltrates?
- Plaques, calcification, pleural fluid, pneumothorax?
- Bones (vertebrae, scapula, ribs):
- Normal structure of marrow?
- Degenerative abnomalities?
- Focal lytic or sclerotic processes?
- 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.
- Can J Surg. Oct 2008; 51(5): E111–E112. PMCID: PMC2556542Management of intrathoracic goitre, Pia Pace-Asciak* and Kevin Higgins†