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Posterior Mediastinal Goiters: Literature Review and Report of Three Cases

Department of Cardiovascular and Thoracic Surgery 1 Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh, India

For reprint information contact: Rajinder Singh Dhaliwal, MCh Tel: 91 172 74 7585 Ext. 400 Fax: 91 172 74 4401 P.O. Box 1515 (PGI-Campus), Chandigarh 160012, India.

Posterior mediastinal goiters are very rare and occur mostly due to descent of a posterolaterally enlarging inferior pole of the thyroid gland, or very infrequently to failure of fusion of the ultimobranchial bodies with the isthmus in the 7th embryonic week. Most patients present with a cervical mass and symptoms due to compression or distortion of the trachea, esophagus, or superior vena cava. The diagnosis is established by chest skiagram, computed tomography scan, and barium esophagogram. Progressive enlargement, risk of sudden hemorrhage within the gland causing respiratory impairment, and the possibility of associated malignancy, make excision of the goiter mandatory. A combined cervicothoracic approach is the procedure of choice as it provides easy access and visualization, better control of blood vessels, and avoids the risk of perioperative tumor seeding. We present our experience of 3 such cases successfully managed at our institute. All 3 patients presented with a cervical mass and symptoms of posterior mediastinal compression; one had thyrotoxicosis. A combined cervicothoracic approach was used for surgical excision with excellent results.