Extensive sterile abscess in an invasive fibrous thyroiditis (Riedel's thyroiditis) caused by an occlusive vasculitis.
Riedel's thyroiditis is a rare disease determined by an invasive fibrosclerotic transformation of the thyroid gland. It may be one manifestation of multifocal fibrosis with still unknown etiology. Because it mimics carcinoma, a biopsy must be performed to get the correct diagnosis. The condition is self-limiting when confined to the neck. Prognosis depends on the extent of extracervical fibrosclerosis. We present a patient with a huge cervical and mediastinal, unilateral thyroid mass expanding to the aortic curve, which led to tracheal deviation and compression with symptoms of stridor and dyspnea. These symptoms continued under a course of high-dose steroids; thus an operation was necessary to relieve the airway obstruction and limit inflammation. Intraoperative and pathological findings showed an inflammatory infiltration of the adjacent neck muscles and a sterile abscess caused by an occlusive vasculitis. Therefore, hemithyroidectomy had to be performed instead of a local limited resection.
Department of General and Visceral Surgery, Zentralklinikum, Augsburg, Germany.
B
B
Geissler
T
T
Wagner
R
R
Dorn
F
F
Lindemann
D000038:Abscess / Q000209:etiology*; D000368:Aged; D005355:Fibrosis; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009504:Neutrophils / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology; D012598:Sclerosis; D013961:Thyroid Gland / Q000473:pathology*; D013965:Thyroidectomy; D013966:Thyroiditis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D014657:Vasculitis / Q000150:complications*