Primary intrathoracic goitre.

A 51 year-old-female was incidentally found to have a mediastinal mass on a routine chest radiograph in February, 2006 (Fig. 1). Subsequent computerized chest tomography (CT) demonstrated a 6.3 × 4.8 cm, irregular and enhancing right suprahilar mass displacing the trachea to the left and extending inferiorly to the carina. A transthoracic needle biopsy was performed showing thyroid follicles with colloid consistent with a mediastinal goiter. As she was asymptomatic, the patient opted for continued surveillance. Of note, the patient had previously undergone a left thyroid lobectomy for a benign goiter in 1987. In May, 2009 a repeat chest CT scan showed the mediastinal mass to have increased in size to 8.0 × 6.5 cm. The mass was discontinuous with the residual right lobe of the thyroid (Figs 2A and B). Other than occasional dysphagia, the patient remained otherwise asymptomatic. Surgical resection of the mass was performed via a limited muscle sparing right thoracotomy. The mass was resected intact from the middle mediastinum where it was not invading but closely juxtaposed to the superior vena cava anteriorly, azygous vein inferiorly, and trachea medially (Figs 3A and B). The blood supply was from segmental arterial branches of the ascending aorta. Final pathologic evaluation confirmed a benign ectopic thyroid mass weighing 179 grams (Figs 4A and B). The patient was discharged home on the third postoperative day. Her dysphagia has improved and her recovery has been uneventful.