-
Laryngoscope Investigative... Apr 2018In a retrospective study, the authors analyzed the surgical approach to the intrathoracic goiter to avoid sternotomy or thoracotomy.
OBJECTIVE
In a retrospective study, the authors analyzed the surgical approach to the intrathoracic goiter to avoid sternotomy or thoracotomy.
METHODS
We selected 70 intrathoracic cases of multinodular goiter out of 988 cases of thyroidectomy and compared them with cervical goiter cases. Surgical technique, results, and postsurgical complications were assessed.
RESULTS
The analyzed cases presented the retrosternal goiter (n = 53; 75.7%), the retrotracheal goiter (n = 9; 12.8%), and the retroesophageal goiter (n = 8; 11.4%). Complaining of chest pressure or discomfort was specific for intrathoracic cases (50%; 35 of 70). All goiters except one were removed via cervical incision. The surgeons used head reclination and isthmus dissection when removing sizable goiters. Mean weight of goiters was 180 g. The recurrent laryngeal nerve was more often temporarily damaged in intrathoracic cases in comparison with cervical cases (4.3% vs. 2.8%, = .04), but the difference in permanent injury was less significant ( = .09). The incidence of temporary hypoparathyroidism was significantly higher in intrathoracic cases ( = .01).
CONCLUSION
In cases of multinodular goiter the goiters of various extensions can be successfully removed via the cervical incision in most of the cases even if they occupy the retrosternal, retrotracheal, or retroesophageal position. The transthoracic approaches and sternotomy might be justified in malignant cases.
LEVEL OF EVIDENCE
4.
PubMed: 29721546
DOI: 10.1002/lio2.146 -
Turkish Archives of Otorhinolaryngology Mar 2017Extraskeletal Ewing's sarcoma is a rare tumor, and the management of airway compromise in case of cervical Ewing's sarcoma has not been established. This report...
Extraskeletal Ewing's sarcoma is a rare tumor, and the management of airway compromise in case of cervical Ewing's sarcoma has not been established. This report describes the case of a patient with retrotracheal Ewing's sarcoma and discusses a successful approach to airway management. A 12-year-old male presented with a 2-week history of sore throat and sleep-disordered breathing and 48 hours of stridor. Imaging confirmed a retrotracheal soft tissue mass with airway compromise. A planned and controlled approach to his airway management resulted in a secure airway prior to definitive treatment.
PubMed: 29392053
DOI: 10.5152/tao.2017.1964 -
Translational Pediatrics Jul 2021Retroesophageal or retrotracheal left brachiocephalic vein (LBCV) is a rare anatomic variant that is often associated with congenital heart disease. It is rarely...
Retroesophageal or retrotracheal left brachiocephalic vein (LBCV) is a rare anatomic variant that is often associated with congenital heart disease. It is rarely reported in fetal life, and an isolated fetal retroesophageal LBCV has a good prognosis: it is typically asymptomatic, although respiratory symptoms or swallowing disorders occasionally occur. A variant was observed on fetal echocardiography at 22 weeks of gestation. The 3-vessel view revealed a transverse section of a vessel to the left of the pulmonary artery. Tracing upwards along its long axis showed that the left subclavian vein joined the left internal jugular vein to form the LBCV, and tracing downwards revealed that the vessel traveled to the right and lower side, where it merged into the superior vena cava via the azygos vein behind the aortic arch. The variant was identified as retrotracheal LBCV. Three-dimensional (3D) reconstruction of fetal great vessels was performed using temporal spatial correlation imaging. The left internal jugular vein and the left subclavian vein converged into the LBCV, then bypassed behind the trachea and converged into the superior vena cava via the azygous vein. As a 3D technique, spatio-temporal image correlation (STIC) can visualize the abnormal courses of LBCV, thus improving the diagnostic accuracy. This article presents the 2-dimensional (2D) ultrasound, color Doppler, and STIC findings of an isolated retrotracheal LBCV, which may inform the sonographic diagnosis of such variants.
PubMed: 34430446
DOI: 10.21037/tp-21-230 -
Ultrasound in Obstetrics & Gynecology :... Oct 2016The left brachiocephalic vein (LBCV), or innominate vein, connects the left jugular vein to the right superior vena cava. Its course is posterior to the thymus and...
OBJECTIVE
The left brachiocephalic vein (LBCV), or innominate vein, connects the left jugular vein to the right superior vena cava. Its course is posterior to the thymus and directly anterior and superior to the aortic arch. Pediatric and adult cardiology studies have reported on the subaortic or retrotracheal courses of the LBCV and the presence of double LBCV. We observed recently in the fetus that the LBCV may have a course through the thymus (intrathymic) or be absent in the presence of a left superior vena cava. The aim of this study was to report the prevalence of isolated intrathymic and absent LBCV in normal fetuses undergoing second-trimester ultrasound screening, as well as the prevalence of other courses in association with cardiac anomalies.
METHODS
In the prospective part of this study, consecutive second-trimester ultrasound examinations were evaluated to assess the presence and course of the fetal LBCV. In the retrospective case-control part of this study, the databases of two fetal medicine centers were reviewed for cardiac anomalies and the pattern and prevalence of anomalous courses of the LBCV were reported.
RESULTS
One thousand four hundred and eighteen consecutive fetuses were examined prospectively. An intrathymic course of the LBCV with a typical bent shape was found in 1.76% (1 : 57) of cases and the absence of a LBCV in association with a persistent left superior vena cava (LSVC) was found in 0.28% (1 : 350). All fetuses with an isolated intrathymic course or absence of the LBCV had a normal outcome. Over a period of 4.5 years, a total of 1544 fetuses with cardiac malformations were reviewed at two centers. Among these, an anomalous course of the LBCV was noted in eight (0.5%) cases: six subaortic, one retrotracheal and one double LBCV.
CONCLUSION
An intrathymic LBCV is a common condition and appears to be a normal variant in the fetus. The prevalence of a LSVC in our screening population was similar to that reported in previous studies. Anomalous courses of the LBCV are seen occasionally in cases with cardiac malformation. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Brachiocephalic Veins; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Retrospective Studies; Thymus Gland; Ultrasonography, Prenatal
PubMed: 26499470
DOI: 10.1002/uog.15795 -
Ear, Nose, & Throat Journal Jul 2015Lipoblastoma is extremely rare and mainly occurs in children younger than 3 years old. It is predominantly found in the extremities and trunk. Head and neck region...
Lipoblastoma is extremely rare and mainly occurs in children younger than 3 years old. It is predominantly found in the extremities and trunk. Head and neck region occurrences are rare; only 4 such cases involving patients who presented with stridor have been previously reported. We report the fifth case of lipoblastoma of the neck with stridor in a 9-year-old girl, which had gradually worsened over the previous year. Imaging showed a retrotracheal mass extending superiorly to the thyroid level and inferiorly to below the carina of the trachea. Total resection of the tumor was performed, and the histopathologic findings were consistent with lipoblastoma. Postoperatively, the patient was well with no complications.
Topics: Biopsy; Child; Female; Head and Neck Neoplasms; Humans; Lipoblastoma; Respiratory Sounds; Tomography, X-Ray Computed
PubMed: 26214680
DOI: 10.1177/014556131509400715 -
Medicine Sep 2018Lateral neck radiography is often used as a screening tool in emergency departments for suspected acute epiglottitis. The qualitative radiographic signs have been mainly... (Observational Study)
Observational Study
Lateral neck radiography is often used as a screening tool in emergency departments for suspected acute epiglottitis. The qualitative radiographic signs have been mainly used. The aim of this study was to evaluate the accuracy of objective radiographic parameters to aid diagnosis of acute epiglottitis.Patients who were diagnosed with acute epiglottitis from January 2006 to December 2016 were included in this case-control study. Control subjects with normal lateral neck radiograph findings were included at a 1:4 ratio during the same period. The clinical findings of the patients were assessed from electronic medical records and radiographs were interpreted by a board-certified radiologist and a board-certified emergency medicine physician. The widths of the 3rd cervical vertebral body, epiglottis base (EWB), epiglottis tip (EWT), aryepiglottic fold (AFW), and hypopharynx, as well as the dimensions of the retropharyngeal and retrotracheal soft tissues, were retrospectively measured. The sensitivity, specificity, and receiver operating characteristic (ROC) curves were analyzed for the measured parameters, and cutoff values were determined to predict acute epiglottitis. The predictive cutoff values of radiologic parameters were evaluated using 5-fold cross-validation.A total 260 epiglottitis patients and 1166 controls were included in the study. In the ROC curve analysis, the EWB had an area under the ROC curve (AUROC) of 0.99 for a cutoff value of 5.02 mm (sensitivity, 96.2%; specificity, 98.2%). The EWT had an AUROC of 0.97 for a cutoff value of 4.84 mm (sensitivity, 91.2%; specificity, 97.3%). The AFW had an AUROC of 0.88 for a cutoff value of 6.59 mm (sensitivity, 86.5%; specificity, 78.8%). The 5-fold cross-validation achieved AUROCs of 0.97 for EWB, 0.94 for EWT, and 0.83 for AFW.The objective radiographic parameters in lateral neck radiography may be useful in diagnosing acute epiglottitis. Further prospective studies may be warranted to evaluate the diagnostic performance in actual clinical practice.
Topics: Acute Disease; Adult; Aged; Case-Control Studies; Cervical Vertebrae; Epiglottitis; Female; Humans; Hypopharynx; Male; Middle Aged; Prospective Studies; ROC Curve; Reference Values; Retrospective Studies
PubMed: 30212960
DOI: 10.1097/MD.0000000000012256 -
Pakistan Journal of Medical Sciences 2018The retrosternal goiter (RSG), which can be defined by different classification and its incidence between 2% and 26% of all thyroidectomized patients, is a thyroid gland...
OBJECTIVES
The retrosternal goiter (RSG), which can be defined by different classification and its incidence between 2% and 26% of all thyroidectomized patients, is a thyroid gland disease. Our aim was to classify RSG cases with a couple of different ways, which we have detected in computed tomography (CT) imaging of the thorax.
METHODS
In this retrospective study conducted at Kars Harakani State Hospital Pulmonary Medicine Polyclinic between June 2014 and June 2017 in which 176 patients were included. The age, sex, diagnostic codes, retrosternal extension of the thyroid gland (aortic upper arch, aortic reaching arch and aortic inferior arch), extension type (prevascular, paratracheal retrovascular and retrotracheal), extension amount (mm) (<50% and 50%<) of thyroid gland of the patients were assessed.
RESULTS
About 56.25% (n=99) were female and the mean age was 65.9±11.4 years. The most common co-morbid disease in patients with RSG was Chronic Obstructive Pulmonary Disease (COPD) (52.3%). Thirty nine (22.2%) of the patients had associated nodule, 16 (9.1%) had accompanying tracheal pressure and one patient had nodule and tracheal pressure. 27.3% of the patients' gland's right lobe and 28.9% of the patients' left lobe were extended >50% below the thoracic entry. Left thyroid gland's (90.3%) retrosternal extension and aortic arch spread (91.2%) were more. When classified according to the trachea, the left lobe's paratracheal and retrovascular extension (50.9%) was more. Extension amounts were similar for both thyroid lobes.
CONCLUSION
In patients who have retrosternal goiter, goiter spread can be defined with multiple classification with thorax CT.
PubMed: 30559810
DOI: 10.12669/pjms.346.15932 -
BMJ Case Reports Aug 2016A 46-year-old man was referred to our ear, nose and throat department after the accidental discovery of a large retrotracheal mass. In order to obtain the diagnosis and...
A 46-year-old man was referred to our ear, nose and throat department after the accidental discovery of a large retrotracheal mass. In order to obtain the diagnosis and to plan treatment he underwent a full battery of tests (CT, MRI, blood tests, hormonal assays, ultrasounds, thyroid scintigraphy, urine tests and fine-needle aspiration of the mass), but none of these was able to define the true nature of such cervical mass. Only after surgical excision and histological evaluation, it was diagnosed as an exceptional case of giant non-functional parathyroid adenoma.
Topics: Adenoma; Diagnosis, Differential; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neck; Parathyroid Neoplasms; Physical Examination; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27535730
DOI: 10.1136/bcr-2016-215973 -
International Journal of Surgery Case... Mar 2022Granular cell tumors (GCT) are rare tumors that most frequently present in the oral cavity. While some present within the gastrointestinal tract, a GCT near the trachea...
INTRODUCTION
Granular cell tumors (GCT) are rare tumors that most frequently present in the oral cavity. While some present within the gastrointestinal tract, a GCT near the trachea is an extremely rare occurence.
PRESENTATION OF CASE
A 42-year-old man presented to the Emergency Department after a motor vehicle accident. A computerized tomography (CT) scan revealed an incidental soft tissue 3.2 × 5.5 cm mass anterior to the esophagus and posterior to the trachea with no adjacent lymphadenopathy. The patient denied dyspnea, voice changes, or dysphagia. Due to its size and location, the patient underwent a transcervical excision of the retrotracheal tumor. Tumor cells were positive for CD68, CD163, S100, and SOX10, confirming a GCT.
CONCLUSION
This is a distinctive presentation of a large (5 cm) GCT in the plane between the trachea and esophagus. GCTs are not often on the differential diagnosis of masses that present in this region.
PubMed: 35193010
DOI: 10.1016/j.ijscr.2022.106844 -
Global Pediatric Health 2018
PubMed: 29552601
DOI: 10.1177/2333794X18762689