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Mediastinal Goiter
Santiago Martínez-Jiménez, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Goiter: Enlarged thyroid gland
                • Cervical goiter: Completely within neck
                • Retrosternal/substernal goiter: Extension into anterior (prevascular) mediastinum
                • Mediastinal goiter: Extension into retrotracheal/retroesophageal mediastinum
                  • Primary goiter: Origin in ectopic thyroid tissue; supplied by intrathoracic vessels
                  • Secondary goiter: Origin in cervical thyroid; supplied by neck vessels
                • Coexisting thyroid cancer in up to 5-15% of all goiters

              IMAGING

              • General Features

                • Radiographic Findings

                  • Fluoroscopic Findings

                    • CT Findings

                      • MR Findings

                        • Ultrasonographic Findings

                          • Nuclear Medicine Findings

                            • Imaging Recommendations

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  • Gross Pathologic & Surgical Features

                                    • Microscopic Features

                                      CLINICAL ISSUES

                                      • Presentation

                                        • Demographics

                                          • Natural History & Prognosis

                                            • Treatment

                                              DIAGNOSTIC CHECKLIST

                                              • Consider

                                                • Image Interpretation Pearls

                                                  Selected References

                                                  1. Traylor KS: Computed tomography and MR imaging of thyroid disease. Radiol Clin North Am. 58(6):1059-70, 2020
                                                  2. Tessler FN et al: ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. J Am Coll Radiol. 14(5):587-95, 2017
                                                  3. Batori M et al: Surgical treatment of retrosternal goiter. Eur Rev Med Pharmacol Sci. 11(4):265-8, 2007
                                                  4. Chin SC et al: Spread of goiters outside the thyroid bed: a review of 190 cases and an analysis of the incidence of the various extensions. Arch Otolaryngol Head Neck Surg. 129(11):1198-202, 2003
                                                  5. Bonnema SJ et al: MR imaging of large multinodular goiters: observer agreement on volume versus observer disagreement on dimensions of the involved trachea. AJR Am J Roentgenol. 179(1):259-66, 2002
                                                  6. Hedayati N et al: The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg. 68(3):245-51; discussion 251-2, 2002
                                                  7. Jennings A: Evaluation of substernal goiters using computed tomography and MR imaging. Endocrinol Metab Clin North Am. 30(2):401-14, ix, 2001
                                                  8. Buckley JA et al: Intrathoracic mediastinal thyroid goiter: imaging manifestations. AJR Am J Roentgenol. 173(2):471-5, 1999
                                                  9. Katlic MR et al: Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital. Am J Surg. 149(2):283-7, 1985
                                                  10. McCort JJ: Intrathoracic goiter; its incidence, symptomatology, and roentgen diagnosis. Radiology. 53(2):227-37, 1949
                                                  Related Anatomy
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                                                  Related Differential Diagnoses
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                                                  References
                                                  Tables

                                                  Tables

                                                  KEY FACTS

                                                  • Terminology

                                                    • Imaging

                                                      • Top Differential Diagnoses

                                                        • Pathology

                                                          • Clinical Issues

                                                            • Diagnostic Checklist

                                                              TERMINOLOGY

                                                              • Definitions

                                                                • Goiter: Enlarged thyroid gland
                                                                • Cervical goiter: Completely within neck
                                                                • Retrosternal/substernal goiter: Extension into anterior (prevascular) mediastinum
                                                                • Mediastinal goiter: Extension into retrotracheal/retroesophageal mediastinum
                                                                  • Primary goiter: Origin in ectopic thyroid tissue; supplied by intrathoracic vessels
                                                                  • Secondary goiter: Origin in cervical thyroid; supplied by neck vessels
                                                                • Coexisting thyroid cancer in up to 5-15% of all goiters

                                                              IMAGING

                                                              • General Features

                                                                • Radiographic Findings

                                                                  • Fluoroscopic Findings

                                                                    • CT Findings

                                                                      • MR Findings

                                                                        • Ultrasonographic Findings

                                                                          • Nuclear Medicine Findings

                                                                            • Imaging Recommendations

                                                                              DIFFERENTIAL DIAGNOSIS

                                                                                PATHOLOGY

                                                                                • General Features

                                                                                  • Gross Pathologic & Surgical Features

                                                                                    • Microscopic Features

                                                                                      CLINICAL ISSUES

                                                                                      • Presentation

                                                                                        • Demographics

                                                                                          • Natural History & Prognosis

                                                                                            • Treatment

                                                                                              DIAGNOSTIC CHECKLIST

                                                                                              • Consider

                                                                                                • Image Interpretation Pearls

                                                                                                  Selected References

                                                                                                  1. Traylor KS: Computed tomography and MR imaging of thyroid disease. Radiol Clin North Am. 58(6):1059-70, 2020
                                                                                                  2. Tessler FN et al: ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. J Am Coll Radiol. 14(5):587-95, 2017
                                                                                                  3. Batori M et al: Surgical treatment of retrosternal goiter. Eur Rev Med Pharmacol Sci. 11(4):265-8, 2007
                                                                                                  4. Chin SC et al: Spread of goiters outside the thyroid bed: a review of 190 cases and an analysis of the incidence of the various extensions. Arch Otolaryngol Head Neck Surg. 129(11):1198-202, 2003
                                                                                                  5. Bonnema SJ et al: MR imaging of large multinodular goiters: observer agreement on volume versus observer disagreement on dimensions of the involved trachea. AJR Am J Roentgenol. 179(1):259-66, 2002
                                                                                                  6. Hedayati N et al: The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg. 68(3):245-51; discussion 251-2, 2002
                                                                                                  7. Jennings A: Evaluation of substernal goiters using computed tomography and MR imaging. Endocrinol Metab Clin North Am. 30(2):401-14, ix, 2001
                                                                                                  8. Buckley JA et al: Intrathoracic mediastinal thyroid goiter: imaging manifestations. AJR Am J Roentgenol. 173(2):471-5, 1999
                                                                                                  9. Katlic MR et al: Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital. Am J Surg. 149(2):283-7, 1985
                                                                                                  10. McCort JJ: Intrathoracic goiter; its incidence, symptomatology, and roentgen diagnosis. Radiology. 53(2):227-37, 1949