Life-threatening giant mediastinal goiter: a surgical challenge

Mediastinal goiter is a well known benign disease, usually resectable throu gh a cervical approach with minimal morbility and mortality. only occasiona lly a median sternotomy or a lateral thoracotomy may be required. The prese nt case is worthy of presentation because of the exceptional dimension of t he disease and the surgical challenge that it presented. In a 72-year-old w oman a large intrathoracic goiter of the right thorax caused a severe dyspn oea due to an important contralateral mediastinal shift with compression of the lung, superior vena cava system and trachea. At surgical exploration, through a cervico-sternotomic approach, the mediastinal structures dislocat ion and the strong adherences between the anomalous neovascularized capsula . of the mass and the surrounding structures, complicated the surgical diss ection. An accidental lesion of the innominate artery required its reimplan tation on the ascending aorta. An immense mass, was finally removed and pat hological examination revealed a rare case of neovascularized, pseudosarcom atoid capsula among a benign hyperplastic proliferation. In spite of its be nign nature, a giant goiter caused a life-threatening compression of the re spiratory tract and lung parenchyma in this patient. The dimension of the l esions, the mediastinal anatomy alterations and the severe intraoperative h aemorrhage represented major technical difficulties during surgical resecti on.