Intrathoracic Goiter

A 69-year-old woman was admitted to the hospital with wheezing and dyspnea. She also complained of hoarseness and slight dysphagia that had caused a loss of 12 lb during the past 4 months. The patient had been treated for bronchial asthma as an outpatient, but the worsening episodes of wheezing were not being controlled by bronchodilator therapy.

The woman's vital signs were stable. Chest examination revealed wheezing that was more prominent on the sternum and over the trachea. A chest film demonstrated a sharply defined anterior mediastinal mass (A). The CT scan confirmed the presence of a retrosternal goiter that was encompassing and constricting the trachea and extending into the thoracic cavity (B).

Drs Manjula Thopcherla, Sonia Arunabh, and Arunabh of Queens, NY, comment that the intrathoracic goiter caused the wheezing, which initially had been misdiagnosed as bronchial asthma. In clinical practice, physicians usually encounter wheezing as a manifestation of bronchospasm in such diseases as bronchial asthma. However, wheezing can occur in other conditions that must be considered in the differential diagnosis, particularly when dyspnea is present and the patient fails to respond to bronchodilator therapy. These disorders include endobronchial obstructions, congestive heart failure, pulmonary embolism, and an extraluminal mass that constricts the tracheobronchial tree.¹

Other than intrathoracic goiter, common causes of an anterior mediastinal mass are thymus gland enlargement and a teratoma. The diagnosis of an intrathoracic goiter can be confirmed by CT, MRI, or ¹³¹I scan.

REFERENCES:1. Leape L. Surgical causes of asthma. In: Berman BA, MacDonnell KF, eds. Differential Diagnosis and Treatment of Pediatric Allergy. Boston: Little, Brown; 1981:117.