Combined Cervical and Video-Assisted Thoracoscopic Approch for Huge Substernal Goiter

Wan Seok Cho; Sang Yun Song; Ho-Cheol Kang; Tae Mi Yoon

doi:10.11106/ijt.2015.8.2.211

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Cho, Song, Kang, and Yoon: Combined Cervical and Video-Assisted Thoracoscopic Approch for Huge Substernal Goiter

Case Report

Int J Thyroidol 2015;8(2):211-215.

Published online: 20 November 2015

DOI: https://doi.org/10.11106/ijt.2015.8.2.211

Combined Cervical and Video-Assisted Thoracoscopic Approch for Huge Substernal Goiter

Wan Seok Cho¹, Sang Yun Song², Ho-Cheol Kang³, Tae Mi Yoon^1,

¹Departments of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea

²Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea

³Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea

Correspondence: Tae Mi Yoon, MD, PhD, Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun 519-763, Korea Tel: 82-61-379-8190, Fax: 82-61-379–8199, E-mail: yoontm@chonnam.ac.kr

Received 18 March 2015 Revised 7 May 2015 Accepted 30 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Substernal goiter is defined as a thyroid mass of which more than half is located below the thoratic inlet. Substernal goiters must be removed surgically due to relation to compressive symptoms, potential airway compromise, and the possibility of an association with malignancy. Thyroidectomy for substernal goiter is usually carried out through a standard cervical approach. However, a few patients with various factors require an extracervical approach, usually by sternotomy. Recently, we successfully removed a substernal goiter that extended to the lower level of the aorta and tracheal carina though the combined cervical and video-assisted thoracoscopic approach. We present this case with a review of the literature.

Keywords: Substernal goiter, Video-assisted thoracic surgery, Chylothorax

References

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Fig. 1.

CT scans with contrast enhancement shows heterogeneous enhanced su-bsternal goiter extending into anterior mediastinum. This substernal mass (black ar-row) is located under the tr-acheal carina (white arrow) and aortic arch (black arrow head) (A. coronal view, B. axial view).

Fig. 2.

Chest X-ray shows left costophrenic angle blunting which is indicated with left pleural effusion (A) and it is improved with conservative treatment (B).

Fig. 3.

Photograph of the surgical specimen shows about longitudinal 9-cm-sized mass originated in inferior portion of left thyroid lobe.

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