164 Mediastinal Goiter

Clinical Presentation

Elderly woman with respiratory distress and a chronic left neck mass

Radiologic Findings

Coned-down PA chest radiograph (Fig. 164.1) demonstrates a large, well-defined left-sided mediastinal soft-tissue mass and an associated ipsilateral neck mass. Note marked mass effect on the cervical and intrathoracic portions of the trachea. Contrast-enhanced chest CT (mediastinal window) (Figs. 164.2, 164.3) shows a large, heterogeneously enhancing soft-tissue mass that arises from the left lobe of the thyroid gland (Fig. 164.2) and extends into the mediastinum (Fig. 164.3). Note the large area of central low attenuation surrounded by irregular enhancing soft tissue and significant mass effect on the trachea, esophagus, and mediastinal great vessels.

Diagnosis

Mediastinal Goiter

Differential Diagnosis

• Thyroid Carcinoma

• Lymphadenopathy; Lymphoma

• Neurogenic Neoplasm

Fig. 164.1

Fig. 164.2

Fig. 164.3

Discussion

Background

Mediastinal (intrathoracic, substernal, retrosternal) goiter refers to thyroid tissue within the mediastinum. Mediastinal goiter affects approximately 5% of the world population. The term substernal goiter

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