A difficult case: ectopic thyroid, bronchial anomalies, and incidentaloma in a patient with lung carcinoma.

CLINICAL SUMMARY Mediastinal enlargement and a solitary pulmonary nodule were detected on a 68-year-old male patient’s chest radiograph during routine annual examination. Computed tomography and magnetic resonance imaging revealed a lobulated, solid, and well-demarcated right paratracheal mass 6 3 4 3 4 cm in dimension (Figure 1). The solitary, heterogeneous parenchymal mass located in the right upper lobe was 4 3 3 3 3 cm in dimension. Results of thyroid function tests were within reference range. Right tracheal bronchus (bronchus suis) was observed on bronchoscopy. Results of bronchoscopy and bronchial lavage cytologic examination were not diagnostic. Positron emission tomography (PET)–computed tomography revealed metabolic activity both in the parenchymal mass (standard uptake values 8.3 early and 9.6 late) and in the nodule of left thyroid lobe (standard uptake values 4.1 early and 5.1 late; Figure 1). There was no metabolic activity in the mediastinal mass or mediastinal lymph node stations. Computed tomographically guided transthoracic fine-needle aspiration of the parenchymal mass revealed non–small cell lung carcinoma. Thyroid ultrasonography and scintigraphy with sodium pertechnetate Tc 99m showed mixed hypoechoic and hypoactive nodules in both thyroid lobes. Because of the suspicion of retrosternal goiter, scintigraphy with iodine 131 was performed, revealing that the mass took up radioiodine. The diagnosis was expected to be thyroid malignancy with lung metastasis. Ultrasonographically guided fine-needle aspiration biopsy of the nodule in left thyroid gland with positive results on positron emission tomography was performed for definitive diagnosis. Pathologic examination