Objective: Clinical picture and surgical management of 175 mediastinal goit
ers are discussed in this retrospective study. Method: Between 1979 and 199
6, 175 patients with intrathoracic goiters were operated on at the Thoracic
Surgical Clinic in Budapest. The majority of the goiters were cervicomedia
stinal (n = 138, 79%), past the level of aortic arch, and the others were c
omplete aberrant lesions (n = 37, 21%). Of the patients, 40% (n = 70) were
symptom-free, in the others the clinical picture was dominated by compressi
ve symptoms, among them, in five instances, the initial false, long-lasting
diagnosis was bronchial asthma and, in four cases, vena cava superior synd
rome caused by advanced inoperable malignancy. Twenty-two percent of patien
ts (n = 39) were operated on previously for cervical struma. Eleven percent
(n = 19) of the patients had hyperthyroid symptoms. In 124 cases the goite
rs were located in the anterior mediastinum. The majority (n = 96) of cervi
comediastinal goiters (n = 138) could be removed through a cervical access,
in the others an additional sternotomy (n = 31), Or anterior thoracotomy (
n = 11) were necessary. For resection of complete intrathoracic goiters (II
= 37) standard thoracotomy (n = 30) or median sternotomy (n = 7) were used
guided by retrotracheal or substernal position. Results: Hospital mortalit
y was 1.1%. Minor complications occurred in 46 cases (26%) and laryngeal ne
rve palsy in 14 patients (8%). Tracheomalatia developed in 18 patients (10%
) which were mainly solved by tracheal intubation for 4-6 days. Ninety-four
percent (n = 165) of the lesions proved to be diffuse colloid or adenomato
us goiters by histology and 10 were (mostly follicular type) carcinomas. Co
nclusions: Unrecognized mediastinal goiters can produce asthma like symptom
s, which may lead to late or misdiagnosis and deficient treatment. Once the
diagnosis and exact extent of mediastinal goiter is established multimodal
surgical approaches are indicated for its safe removal - before occurrence
of compressive symptoms. (C) 1998 Elsevier Science B.V. All rights reserve
d.