title: The surgical approach to retrosternal goiters: the role of computerized tomography.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  In such cases in which sternotomy is anticipated, the availability of cardiothoracic services would be helpful to avoid patient morbidity.
authors.affiliation: Department of Otorhinolaryngology, University Hospital of North Staffordshire, City General Hospital, Stoke-on-Trent, United Kingdom. joegrainger@fsmail.net
authors.forename: Joe
authors.initials: J
authors.lastname: Grainger
authors.forename: Natarajan
authors.initials: N
authors.lastname: Saravanappa
authors.forename: Alwyn
authors.initials: A
authors.lastname: D'Souza
authors.forename: David
authors.initials: D
authors.lastname: Wilcock
authors.forename: Paul S
authors.initials: PS
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006042:Goiter / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed