scholarly journals Preoperative Evaluation of Substernal Goiter by Computed Tomography in the Extended Neck Position

2021 ◽  
pp. 1353-1358
Author(s):  
Teruhisa Yano ◽  
Takuro Okada ◽  
Hiroki Sato ◽  
Ryota Tomioka ◽  
Kiyoaki Tsukahara
Keyword(s):  
Computed Tomography ◽  
Aortic Arch ◽  
Preoperative Evaluation ◽  
Neck Mass ◽  
Pathological Examination ◽  
Neck Position ◽  
Substernal Goiter ◽  
Cervical Incision ◽  
Preoperative Ct ◽  
Cervical Approach

Sternotomy is indicated when a goiter cannot be resected via a cervical incision, such as in the case of a substernal goiter extending beyond the aortic arch. In this article, we report a case of a large substernal goiter that was successfully removed using the cervical approach only. This is a case of a 68-year-old woman, diagnosed with goiter 20 years ago, who complained of a neck mass enlargement with associated cough. Pathological examination revealed no malignancy. Computed tomography (CT) scan showed an 11-cm thyroid mass reaching the level of the aortic arch. Preoperatively, we evaluated the substernal extent of the goiter via CT in the extended neck position to decide whether sternotomy was necessary. With the patient’s neck extended, the goiter withdraws cranially above the aortic arch. The mass was then removed via the cervical approach without sternotomy. Preoperative CT in the extended neck position was thus deemed helpful in deciding whether or not sternotomy was required.

The surgical approach to retrosternal goiters: The role of computerized tomography

2005 ◽  
Vol 132 (6) ◽  
pp. 849-851 ◽  
Author(s):  
JOE Grainger ◽  
Natarajan Saravanappa ◽  
Alwyn D'souza ◽  
David Wilcock ◽  
Paul S Wilson
Keyword(s):  
Aortic Arch ◽  
Median Sternotomy ◽  
District General Hospital ◽  
Ct Scans ◽  
The United Kingdom ◽  
Cervical Incision ◽  
Patient Morbidity ◽  
Retrosternal Goiter ◽  
Major Vessel ◽  
Preoperative Ct

OBJECTIVE: To assess preoperative CT scans of patients with a retrosternal goiter, with an objective of identifying features that are likely to predict the need for sternotomy at operation. STUDY DESIGN AND SETTING: A retrospective review of clinical notes and CT scans of patients who underwent thyroidectomy for retrosternal goiter at a large district general hospital in the United Kingdom between 1998 and 2002. RESULTS: Extension of the goiter to the level of the aortic arch, particularly when combined with tracheal involvement or major vessel displacement, increases the likelihood of requiring median sternotomy. CONCLUSIONS: Most retrosternal goiters can be approached through a cervical incision alone. However, extension of the goiter to the level of the aortic arch does appear to increase the likelihood of requiring sternotomy. SIGNIFICANCE: In such cases in which sternotomy is anticipated, the availability of cardiothoracic services would be helpful to avoid patient morbidity.

scholarly journals Perioperative evaluation of neonatal aortic arch thrombosis

2021 ◽  
Author(s):  
fumiya yoneyama ◽  
Travis Wilder ◽  
Michiaki Imamura
Keyword(s):  
Computed Tomography ◽  
Aortic Arch ◽  
Critical Condition ◽  
Preoperative Evaluation ◽  
Coarctation Of The Aorta ◽  
Postoperative Evaluation ◽  
Aortic Arch Repair ◽  
Thrombus Removal

Herein, we present a neonatal case of coarctation of the aorta, with aortic arch thrombus confirmed by echocardiography. We performed thrombus removal and aortic arch repair emergently. This critical condition necessitates quick preoperative evaluation with echocardiography. Moreover, postoperative evaluation using computed tomography is reasonable to assess an aortic arch configuration, and exclude the remnant thrombus.

scholarly journals Substernal Goiter: When is a Sternotomy Required?

2014 ◽  
Vol 99 (4) ◽  
pp. 419-425 ◽  
Author(s):  
Ali Coskun ◽  
Mehmet Yildirim ◽  
Nazif Erkan
Keyword(s):  
Postoperative Complications ◽  
Thyroid Tissue ◽  
Median Sternotomy ◽  
Substernal Goiter ◽  
Cervical Incision ◽  
Patient Consent ◽  
Cervical Approach ◽  
Transient Paralysis ◽  
Preoperative Predictors ◽  
Tracheal Bifurcation

Abstract The presence of substernal goiter is, per se, an indication for surgical management. Surgical approach of substernal goiter can most commonly be performed using the cervical access, but at times, a sternotomy or thoracotomy is necessary. The aim of this study was to identify the preoperative predictors of a sternotomy in the management of substernal goiter in order to provide better preoperative planning and patient consent. Between 2005 and 2012, 665 patients were referred to our clinic for thyroidectomy, 42 patients (6.3%) had substernal goiter and were included in this study. All substernal goiters were treated surgically, 38 (90.5%) by a cervical approach and 4 (9.5%) by full median sternotomy. All surgeries were successful, with no major postoperative complications. Minor postoperative complications of transient hypocalcemia and transient paralysis of the recurrent laryngeal nerve occurred in 5 (11.9%) and 2 (4.7%) cases, respectively. Indication of median sternotomy was as follows: extension of goiter below the aortic arch, large thyroid tissue extending towards tracheal bifurcation, and ectopic thyroid tissue in the mediastinum. Substernal goiter can be removed through a cervical incision, but on rare occasions, a median sternotomy may be required.

Can the multiphasic computed tomography be useful in the clinical management of small renal masses?

2016 ◽  
Vol 58 (5) ◽  
pp. 625-633 ◽  
Author(s):  
Caterina Gaudiano ◽  
Riccardo Schiavina ◽  
Valerio Vagnoni ◽  
Fiorenza Busato ◽  
Marco Borghesi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Management ◽  
Preoperative Evaluation ◽  
Correct Diagnosis ◽  
Morphological Features ◽  
Renal Tumors ◽  
Pathological Examination ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Significant Difference

Background Small renal masses (SRMs; ≤4 cm) represent a challenging issue. Computed tomography (CT) is widely used for investigating renal tumors even if its ability to differentiate among the different subtypes has not yet been definitively established. Purpose To assess the potential role of the morphological features and angiodynamic behavior on multiphasic CT in the preoperative evaluation of SRMs. Material and Methods The CT images of 80 patients with SRMs who underwent surgical resection at our institution were retrospectively reviewed. The morphological features, the pattern, and the quantitative analysis of enhancement were assessed for each lesion and were correlated with the histological subtypes. Results Overall, 81 SRMs were evaluated. Final pathological examination showed 30 (37%) oncocytomas, 22 (27.2%) clear cell renal cell carcinomas (ccRCCs), 16 (19.8%) papillary RCCs (pRCCs), and 13 (16%) chromophobe RCCs (chRCCs). Of the morphological features, only necrosis was significantly associated with ccRCC ( P = 0.047). The analysis of enhancement allowed the identification of two groups of lesions, based on arterial behavior: hypervascular (oncocytomas/ccRCC) and hypovascular (chRCC/pRCC) lesions. A significant difference between the two groups in terms of degree of enhancement on CT phases was found ( P < 0.05); this was also confirmed by the receiver operating characteristic (ROC) analysis. Conclusion Except for necrosis, the morphological features are not useful in making a correct diagnosis in the case of SRMs. The angiodynamic behavior on multiphasic CT showed high accuracy in differentiating between hypovascular and hypervascular tumors; this differentiation could be useful for deciding on the most appropriate clinical management of SRMs.

scholarly journals Submandibular Lateral Ectopic Thyroid Tissue: Ultrasonography, Computed Tomography, and Scintigraphic Findings

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Metin Çeliker ◽  
Fatma Beyazal Çeliker ◽  
Arzu Turan ◽  
Mehmet Beyazal ◽  
Hatice Beyazal Polat
Keyword(s):  
Computed Tomography ◽  
Thyroid Tissue ◽  
Neck Mass ◽  
Ectopic Thyroid ◽  
Follicle Cells ◽  
Pathological Examination ◽  
Submandibular Region ◽  
Ectopic Thyroid Tissue ◽  
Female Case ◽  
Enhanced Computed Tomography

Ectopic thyroid can be encountered anywhere between the base of tongue and pretracheal region. The most common form is euthyroid neck mass. Herein, we aimed to present the findings of a female case with ectopic thyroid tissue localized in the left submandibular region. A 44-year-old female patient, who underwent bilateral subtotal thyroidectomy four years ago with the diagnosis of multinodular goiter, was admitted to our hospital due to a mass localized in the left submandibular area that gradually increased in the last six months. Neck ultrasonography, contrast-enhanced computed tomography, and scintigraphic examination were performed on the patient. On thyroid scintigraphy with Tc-99m pertechnetate, thyroid tissue activity uptake showing massive radioactivity was observed in the normal localization of the thyroid gland and in the submandibular localization. The focus in the submandibular region was excised. Pathological examination of the specimen showed normal thyroid follicle cells with no signs of malignancy. The submandibular mass is a rarely encountered lateral ectopic thyroid tissue. Accordingly, ectopic thyroid tissue should also be considered in the differential diagnosis of masses in the submandibular region.

Cervicothoracic goitre: an anatomical or radiological definition? Report of 223 surgical cases

2007 ◽  
Vol 121 (11) ◽  
pp. 1083-1087 ◽  
Author(s):  
C Page ◽  
V Strunski
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Aortic Arch ◽  
Surgical Management ◽  
Surgical Procedure ◽  
Imaging Modality ◽  
Chest Radiographs ◽  
Resonance Imaging ◽  
Computed Tomography Scans ◽  
Cervical Approach

AbstractObjectives:To analyse and compare chest radiographs and cervicothoracic computed tomography scans taken prior to thyroid surgery, in order to locate and predict thoracic extension of substernal goitres.Method:This eight-year, retrospective study included 223 patients who had undergone total thyroidectomy for benign, substernal, multinodular goitres. Chest radiographs and computed tomography scans were reviewed by two physicians (a senior ENT surgeon and a senior radiologist).Results:The most frequent mode of extension was anterior or prevascular, seen in 76 per cent of cases, especially on the left side. Fifty-nine per cent of goitres did not reach the aortic arch and 11 per cent extended beyond the aortic arch. A cervical surgical approach was performed in approximately 99 per cent of cases.Discussion:Thorough examination of computed tomography scans is essential in order to identify and classify substernal goitres and to decide the best surgical procedure. A cervical surgical procedure is almost always sufficient and safe for the surgical management of substernal goitres.Conclusion:Computed tomography appears to be the best imaging modality for identifying and characterising substernal goitres. Surgical management is almost always via a cervical approach and does not differ from that used for benign cervical goitres. In the future, magnetic resonance imaging may be used; its results would need to be compared with those of computed tomography.

Imaging study of the anatomical variations and the maxillary sinus pathology in patients with missing lateral teeth for the application of dental implants

ORL ro ◽  
2016 ◽  
Vol 1 (1) ◽  
pp. 6-12
Author(s):  
Iulian Damian ◽  
Gheorghe-Ionel Comșa
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Dental Implants ◽  
Preoperative Evaluation ◽  
Anatomical Variations ◽  
Accurate Information ◽  
Maxillary Artery ◽  
Lateral Sinus ◽  
Sinus Wall ◽  
Increased Risk

Preoperative evaluation of maxillary sinus anatomy is very important to avoid surgical complications due to close anatomical relations between the sinus and the posterior maxillary teeth and/or edentulous alveolar ridge. Posterior superior alveolar artery is a branch of the maxillary artery and provides the vascularization of the lateral sinus wall and underlying mucosa. Maxillary artery branches should be taken into consideration during sinus lifting procedures and bone augmentation due to increased risk of bleeding by damaging the artery during the osteotomy. Computed tomography (CT) explores three-dimensional anatomic structures and provides complex and accurate information about them. Cone Beam Computed Tomography (CBCT) offers an accurate view of the teeth and surrounding structures at high resolution, despite low-dose radiation used. In this study, the incidence of anatomical variations and sinus pathology were assessed using CBCT. The aim is to evaluate the presence of sinus pathology (sinus mucosal thickening, oro-antral communications, sinus tumors, cysts, polyps), presence and position of the posterior superior alveolar artery. These issues are important because they are about the limits of the dental implants in the posterior maxillary area. The presence of sinus pathology and anatomical variations may predispose to complications and even failures of implantation therapy.  

Computed tomography for preoperative evaluation of need for sternotomy in surgery for retrosternal goitre

2015 ◽  
Vol 400 (3) ◽  
pp. 293-299 ◽  
Author(s):  
Per Malvemyr ◽  
Nils Liljeberg ◽  
Mikael Hellström ◽  
Andreas Muth
Keyword(s):  
Computed Tomography ◽  
Preoperative Evaluation
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