CASE REPORTS  THORACIC SECTION 

The Journal of Cardiovascular Surgery 2001 June;42(3):429-30

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Life-threatening giant mediastinal goiter: a surgical challenge

Veronesi G., Leo F., Solli P. G., D’Aiuto M., D’Ovidio F., Mazzarol G., Spaggiari L., Pastorino U.

From the Department of Thoracic Surgery, *Department of Pathology, European Institute of Oncology, Milan, Italy

Med­i­as­tinal ­goiter is a ­well ­known ­benign dis­ease, usu­ally resect­able ­through a cer­vical ­approach ­with min­imal mor­bility and mor­tality. ­Only occa­sion­ally a ­median ster­notomy or a lat­eral thor­a­cotomy may be ­required. The ­present ­case is ­worthy of pres­en­ta­tion ­because of the excep­tional dimen­sion of the dis­ease and the sur­gical chal­lenge ­that it pre­sented. In a 72-­year-old ­woman a ­large intra­tho­racic ­goiter of the ­right ­thorax ­caused a ­severe dysp­noea due to an impor­tant con­tra­lat­eral med­i­as­tinal ­shift ­with com­pres­sion of the ­lung, ­superior ­vena ­cava ­system and tra­chea. At sur­gical explo­ra­tion, ­through a cer­vico-ster­no­tomic ­approach, the med­i­as­tinal struc­tures dis­lo­ca­tion and the ­strong adher­ences ­between the anom­a­lous neo­vas­cu­lar­ized cap­sula of the ­mass and the sur­rounding struc­tures, com­pli­cated the sur­gical dis­sec­tion. An acci­dental ­lesion of the innom­i­nate ­artery ­required its reim­plan­ta­tion on the ­ascending ­aorta. An ­immense ­mass, was ­finally ­removed and path­o­log­ical exam­ina­tion ­revealed a ­rare ­case of neo­vas­cu­lar­ized, pseu­do­sar­com­a­toid cap­sula ­among a ­benign hyper­plastic pro­life­ra­tion. In ­spite of its ­benign ­nature, a ­giant ­goiter ­caused a ­life-threat­ening com­pres­sion of the res­pir­a­tory ­tract and ­lung paren­chyma in ­this ­patient. The dimen­sion of the ­lesions, the med­i­as­tinal ­anatomy alter­a­tions and the ­severe intra­op­er­a­tive hae­mor­rhage rep­re­sented ­major tech­nical dif­fi­cul­ties ­during sur­gical resec­tion.