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| IMAGE QUIZ |
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| Year : 2015 | Volume
: 3
| Issue : 2 | Page : 185 |
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Intrathoracic Mass
Yasser Elghoneimy
Department of Cardiothoracic Surgery, College of Medicine, University of Dammam and King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia
| Date of Web Publication | 6-May-2015 |
Correspondence Address:
Yasser Elghoneimy
P.O. Box 40233 Alkhobar 31952
Kingdom of Saudi Arabia
 DOI: 10.4103/1658-631X.156446 
How to cite this article:
Elghoneimy Y. Intrathoracic Mass. Saudi J Med Med Sci 2015;3:185 |
A 48-year-old female patient who is not known to have any medical illness presented with complaints of chronic cough and dyspnea, progressive in nature over the last 6 months. The cough is dry in nature with no hemoptysis and was not associated with chest pain. There was no loss of appetite or weight.
Chest X-ray [Figure 1] showed a well-circumscribed homogenous opacity on the upper right side, measuring 10 cm × 12 cm in size without shifting of the trachea to the other side.
The computed tomography scan of the chest [Figure 2] confirmed the presence of soft tissue mass situated in the right upper lung zone. The mass is rounded with some areas of degeneration; it is not invading the surrounding structures.
Patient was subjected to surgical resection of the lesion. The histopathology is shown [Figure 3].
| Question | |  |
What is the most probable diagnosis?
 View Answer
| Answer | | |
Daignosis: Intrathoracic Goiter Comments 0Intrathoracic thyroid tissue is a rare condition, which typically causes symptoms of obstruction such as dyspnea, cough or dysphagia. It can lead to significant major airway deviation and/or narrowing. Mediastinal masses such as a large goiter can cause significant airway deviation and/or narrowing. [1] The differential diagnosis includes the following: Bronchogenic cyst, thymic cyst, hamartoma, lymphoma, teratoma and bronchogenic carcinoma. The intrathoracic mass is usually continuous with the thyroid gland in the neck; only 2% of cases are separated from the cervical thyroid. [2] Computed tomography scan of the chest is very helpful in the diagnosis. It provides detailed information on the mediastinal abnormality including its size, location, relation to the surrounding tissues, tissue characteristics, and presence of fluid, fat or calcification. [3] Management of such lesions is by complete surgical resection through video-assisted thoracoscopic surgery or with partial or full sternal split. Careful anesthetic and operative planning is required to ensure safe resection. [4]
| References | | |
| 1. | Katlic MR, Grillo HC, Wang CA. Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital. Am J Surg 1985;149:283-7.  |
| 2. | Lindskog GE, Goldberg IS. Differential diagnosis, pathology and treatment of substernal goiter. JAMA 1957;163:327. |
| 3. | White ML, Doherty GM, Gauger PG. Evidence-based surgical management of substernal goiter. World J Surg 2008;32: 1285-300. |
| 4. | Allo MD, Thompson NW. Rationale for the operative management of substernal goiters. Surgery 1983;94:969-77. |
[Figure 1], [Figure 2], [Figure 3]
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