An investigation into symptoms, diagnosis, treatment, and treatment complications in patients with retrosternal goiter

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study

BACKGROUND

The preferred standard treatment for retrosternal goiter (RSG), a slow-growing, often benign tumor, remains thyroidectomy. An alternative strategy may be required when the goiter is intrathoracic. Data on the results of RSG procedures are rarely reported. Careful patient selection and assessment are critical to avoiding an unexpected sternotomy during surgery and postoperative complications. This study aims to examine the clinical findings and treatment outcomes of RSG and to identify the variables affecting postoperative complications in a resource-limited setting.

METHOD

A retrospective study was conducted at Al-Thawra Modern General Hospital in Sana'a, Yemen, on 69 patients diagnosed with RSG and undergoing thyroidectomy between April 2019 and February 2023. Initial clinical characteristics, radiological and laboratory findings, treatment approach, and outcome were collected from the patient's medical profile and analyzed. To determine the variables influencing postoperative complications, a bivariate analysis was carried out.

RESULTS

The mean age was 51.0 ± 13.6 years, and 45 (65.2%) were female. The most commonly reported symptoms were palpable masses (66; 95.7%), difficulty breathing (45; 65.2%), and neck discomfort (20; 29.0%), with 7 (10.1%) patients being asymptomatic. Previous thyroid surgery was reported in 10 (14.5%) cases. According to the grading classification, grade 1 was the most prevalent (42; 60.9%). Total thyroidectomy was the predominant surgical procedure in 59 (85.5%) cases. Using a cervical approach, all patients underwent thyroidectomy, and a sternotomy was required in one case. Histopathological analysis revealed benign multinodular goiter in 79.7%, followed by papillary thyroid cancer in 10.1% and thyroiditis in 6.7%. The postoperative complication occurred in 22 (31.9%), and the most common complication was transient hypocalcemia (11, 15.9%). There was no mortality during or after the surgery. In bivariate analysis, advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology were associated with postoperative complications and were statistically significant (all p<0.05).

CONCLUSION

RSG is a rare disease that may require challenging surgical intervention. In this study, the cervical approach was the most practical and least intrusive surgical method. In addition, postoperative complications were associated with advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology. Low postoperative complication rates can be achieved by understanding the surgical architecture of the neck, essential clinical RSG presentation, thyroid pathology, and necessary surgical treatment.

Retrosternal goiter masquerading as type II respiratory failure. A case report

Introduction and importance

Case presentation

Conclusion

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Respiratory failure is an unprecedented manifestation of retrosternal goiter (RG).

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CT plays an important role in determining the likelihood of requiring an extra-cervical approach for RG.

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An ectopic goiter, previous neck surgery, extension below the level of the carina and/or into the posterior mediastinum favor an extra-cervical approach.

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A cautious attempt to remove RG through a cervicotomy should always be made, on account of reduced risk of surgical and aesthetic harm with this approach.

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If RG is performed by a skilled surgeon, familiar with its unique pitfalls, the assistance of a thoracic surgeon may seldom be required.

A Case of a Young Woman with Cervico-Mediastinal Malignant Goiter

The main treatment in nearly every case of thyroid cancer is surgery. The exception often refers to anaplastic carcinoma because this cancer is already widespread at the time of diagnosis. Most of the cases are treated with thyroidectomy, but small tumors that spread inside the thyroid gland might be treated by lobectomy. Intrathoracic goiter accounts for 5.8% of all mediastinal masses. On the other hand, the incidence of thyroid malignancy in cervico-mediastinal thyroid masses is 7,7%. In such cases, total thyroidectomy with en block removal of the mediastinal portion of the gland is the treatment of choice. We present a case of a 34-year-old woman with cervico-mediastinal malignant goiter.

Diagnostic Value of Magnetic Resonance (MR) Combined with Computed Tomography (CT) in Patients with Stress Injury of Femoral Neck

BACKGROUND The purpose of this research was to study and analyze the diagnostic value of magnetic resonance (MR) combined with computed tomography (CT) in patients with stress injury of the femoral neck. MATERIAL AND METHODS The 58 patients with stress injury of the femoral neck who were treated in our hospital from July 2017 until July 2019 were selected as subjects on the basis of clinical pathology and surgery, MR and CT examination, and related imaging data retrospectively analyzed. We observed all patients using different diagnostic methods to determine the value of diagnosis and treatment of disease. RESULTS The patients selected for this study were confirmed by clinicopathology and surgery; the positive rate of CT diagnosis was 65.5%, the positive rate of MR diagnosis was 74.1%, and the positive rate of combined diagnosis was 91.4%. Through statistical analysis, CT and MR showed no significant difference in the detection of stress lesions in different femoral necks, indicating no statistical significance (P>0.05). However, the amount of stress lesions detected in the combined diagnosis was higher than that in the two separate detection methods, with statistically significant difference (P<0.05). The grading of stress lesions in all patients examined through MR showed that there was no proportion of grade 0, whereas grades 3-4 were the highest, accounting for 20.7% and 32.8% respectively. In CT scanning of all patients, fracture lines were observed in 35 patients, of which 25 were transparent lines and 10 were strip dense shadows; Periosteal reaction was observed in 34 patients, of whom umbilical concave was observed in 18 patients. Osteoporosis was observed in 30 patients, and the lesion showed a zone of reduced density in the cortical bone, with a stripelike shape and unclear boundary. The density tended to increase in the cavum medullare of 32 patients, with porosis being visible. Compared with CT diagnosis, the accuracy, sensitivity, and specificity of MR detection were not significantly different (P>0.05). The accuracy, sensitivity, and specificity of the combined detection were higher than that of CT and MR detection alone, with statistically significant differences between groups (P<0.05). CONCLUSIONS The application of MR combined with CT in early clinical diagnosis and treatment of femoral neck stress injury will improve the diagnosis rate; the imaging signal is obvious, which is helpful to further evaluate the severity of disease.