Severe tracheal compression by multinodular goiter

Abstract

58-year-old woman with a-6-month history of dizziness with postural changes. She had a 8-month history of multinodular goiter and noted in the last 4-months bitonal voice, dyspnea on exertion and stridor, no other clinicalmanifestations of the mediastinal syndrome were found. The physical examination revealed grade IV goiter with  irregular surface of the thyroid gland, sternal dullness and positive Marañon-Pemberton maneuver, no dyspnea after walking was found. The laryngoscopy revealed 70-75% tracheal stenosis caused by extrinsic compression by thegoiter from the second to the fifth tracheal ring. The CT-scan showed an enlarged thyroid gland of 150x100x85 mm mainly due to enlargement of right lobe with multiple hypodense nodules and calcifications extending to the thorax up to the carina. The thyroid gland encroached the trachea and displaced it to the left causing stenosis of its lumen. The medial aspect of the thyroid gland compressed and deviates the esophagus to the left and compressed the uppercava vein reducing its lumen. A: axial section; B: coronal section showing tracheal stenosis (arrow)