대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 659 Date 2010-06-15

  • Courtesy of Myung Hee Chung / Bucheon St. Mary's Hospital, The Catholic University of Korea
  • Age/Sex 52 / F
  • Chief ComplaintIncidentally found for health check-up
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Diagnosis With Brief Discussion

Diagnosis
Ectopic mediastinal goiter without a link to the cervical thyroid
Radiologic Findings
She was incidentally found to have an ectopic goiter located in the anterior upper mediastinum without symptom. Chest radiography showed no abnormal finding and chest CT identifies two isolated nodules (1.1 and 2.3 cm). They were isodense to thyroid tissue on pre- and post-enhanced CT. There was no evidence of invasion in other organs. The cervical thyroid was almost normal in ultrasonography. No link to the cervical thyroid was detectable. But, PET-CT showed dense increased uptake (SUV; 6.02) in the lower larger nodule. Since malignancy could not be ruled out definitively, the mass was removed by thoracotomy. Pedicle was found between two nodules. Pathologic evaluation confirmed the preoperative diagnosis of ectopic mediastinal goiter.
Brief Review
A primary intrathoracic goiter, although rare, should also be considered in the differential diagnosis of mediastinal tumor (1,2,3). It lacks a connection with the cervical thyroid and their blood supply comes from intrathoracic vessels. It can coexist with a normal or goitrous thyroid gland. When they coexist, either or both may be independently affected by neoplastic, infectious, or infiltrative processes. Follicular adenoma, papillary carcinoma, follicular carcinoma, and primary ectopic thyroid B cell lymphoma have been reported previously (4, 5). CT and radionuclide imaging can suggest or make the diagnosis in most cases. The differential diagnosis includes other mediastinal tumors that show high attenuation on unenhanced CT. The treatment of choice is surgical resection of the goiter through a thoracic approach.
References
1. Bremerich J, Pippert H. Ectopic thyroid tissue: an unusual differential diagnosis of space-occupying mediastinal lesions. Schweiz Med Wochenschr. 1997;127(7):266-70.
2. Foroulis CN, Rammos KS, Sileli MN, Papakonstantinou C. Primary intrathoracic goiter: a rare and potentially serious entity. Thyroid. 2009 Mar;19(3):213-8.
3. Sussman SK, Silverman PM, Donnal JF. CT demonstration of isolated mediastinal goiter. J Comput Assist Tomogr. 1986;10(5):863-4.
4. Demirag F, Cakir E, Aydin E, Kaya S, Akyurek N. Ectopic primary B cell lymphoma of the thyroid presenting as an anterior mediastinal mass. A case report. Acta Chir Belg. 2009;109(6):802-4.
5. Shah BC, Ravichand CS, Juluri S, Agarwal A, Pramesh CS, Mistry RC. Ectopic thyroid cancer. Ann Thorac Cardiovasc Surg. 2007;13(2):122-4.
Keywords
Mediastinum, Benign tumor,

No. of Applicants : 110

▶ Correct Answer : 14/110,  12.7%
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - Seoul Veterans Hospital , Korea (South) Hye Sun Hwang
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - radiologist, aditya imaging centre , India vivek patel
  • - Institute of Chest Diseases,Calicut , India sijith raghavan
  • - Kuang Tien General Hospital , Taiwan Seaharn Pan
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - CHU Grenoble , France Fabrice Bing
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - Chonnam National University Hospital , Korea (South) Daun Lee
▶ Correct Answer as Differential Diagnosis : 21/110,  19.1%
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - CHU NANCY , France, Metropolitan GREGORY LESANNE
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - CHRU Lille , France guillaume lefebvre
  • - Chonbuk National University Hospital , Korea (South) Jisoo Song
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Nonsan Hospital , Korea (South) Eun-Tae Park
  • - royal melbourne hospital , Australia kimchi kings
  • - , Korea (South) Hun-cheol lim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Montreal Chest Institute , Canada Faiz Kham
  • - IRSA Rochefort , France Viviane Pages
  • - NASA SCANS , India RAKESH BHATIA
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Apollo Gleneagles hosp kolkata , India SALIM PARVEZ
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
▶ Semi-Correct Answer : 3/110,  2.7%
  • - Osaka University , Japan Osamu Honda
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
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