Neck mass and tracheostomy in a young lady depicted by Piero di Cosimo

Among surgical procedures currently in use, tracheostomy has a particularly long history. The first written description of the procedure is due to Brasavola, and dates from 1546. Piero di Cosimo (1462–1522) was an early Renaissance painter who painted a work traditionally known as Cephalus and Procris or The Death of Procris (1495–1500). In this painting, a vertical tracheostomy can be observed in a young woman lying on the ground. A giant mass can be seen in the lower left neck with superficial venous vessels, suggesting a thyroid malignancy. This appears to be the first detailed depiction of a malignant cervical mass and a possibly therapeutic tracheostomy. We discuss the clinical differential diagnosis and also make some comments from an art history perspective.