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Importance of PA chest X-ray in patients with goiter

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Author(s): Ömer Karahan

Journal: Journal of Dialog in Endocrinology
ISSN 1306-2514

Volume: 9;
Issue: 1;
Start page: 34;
Date: 2012;
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Keywords: retrosternal goiter | PA chest X-ray | thyroidectomy

ABSTRACT
Aim: Diagnosis of intrathoracic goiter is easy by recentmodalities. However, unless suggested, it can be overlookedeven in patients who have undergone multiplegoiter surgery. We would like to emphasize the importantpoints that require attention in diagnosis and treatment,by presenting two cases of failed intrathoracicgoiter diagnosis although both patients had undergonethyroidectomy, one twice and the other once, along witha third intrathoracic goiter case diagnosed at first consultation,where an intrathoracic nodule was found separatefrom the main gland.Results: 1- K.Ç., 60-year-old female patient, twice undergonethyroidectomy, 20 and 9 years ago. Finally, thepatient was admitted to the clinic of chest diseases dueto a complaint of chest pain, and was referred to the clinicof chest surgery with a diagnosis of intrathoracicmass. The examinations resulted in a diagnosis of recurrentgoiter with an intrathoracic component. We performedtotal thyrodectomy by cervical and thoracicincisions. When we investigated her old files, we determinedan undetected goiter with an intrathoracic componentin her chest X-ray taken 9 years ago. 2- Ş.A.,38-year-old female patient, undergone total thyroidectomyupon diagnosis of retrosternal goiter. Followingthe completion of total thyroidectomy, we detected a secondthyroid nodule in the mediastinal space, with adiameter of 3 cm, and completely free of main thyroidtissue. 3- F.A., 65-year-old male patient, undergonethyroidectomy 20 years ago. We were unable to accesshis old files. He was admitted to our hospital with acomplaint of dispnea. A large portion of his recurrentgoiter on the left side was intrathoracic, and his chestX-ray showed a trachea with an advanced deviation tothe right. We performed total thyroidectomy.Conclusion: In goiter patients, the intrathoracic componentmay be overlooked even during surgery. In orderto avoid overlooking such a condition, chest X-rays shouldalso be examined for intrathoracic component.Furthermore, the possibility of presence of an intrathoracicthyroid tissue, separate from the main thyroidtissue, should be kept in mind.
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