Retrosternal goiter with posterior mediastinal extension surgery in a patient with superior vena cava obstruction through a classic neck incision; Case report

Intrathoracic goiters are usually located anteriorly, in the superior or anterior mediastinum, and are termed substernal or retrosternal goiters. Posterior mediastinal goiters are rare, about 10% of all intrathoracic goiters. Patients with retrosternal goiter usually have a visible or palpable cervical mass. In addition, tracheal deviation may be present with compression symptoms. Posterior mediastinal goiter with mediastinal compressive symptoms is an indication of surgery. Lateral thoracotomy is an alternative approach for intrathoracic goiter extending into the posterior mediastinum. We report a case of 75 years old gentleman, referred with right neck swelling, difficulty in swallowing and breathing and changes of voice. Total thyroidectomy was performed. Histopathology report showed multi nodular goiter with no evidence of malignancy. This patient had both types of extension. Both were delivered successfully through a classic neck incision without sternotomy or combined cervicothoracotomy. It would be reasonable to consider surgical management for such symptomatic goiters if there were no contraindications.