Giant recurrent intrathoracic goitre treated by clamshell thoracotomy and reverse sternotomy.
A 59-year-old man with a giant recurrent intrathoracic goitre was admitted for completion thyroidectomy for recurrent severe retrosternal pain. The patient had undergone a cervical thyroidectomy elsewhere 13 years earlier, during which only the cervical part of the goitre had been resected. Owing to the previous operation with an expected scar around the innominate vein, and the goitre's size and localisation obstructing the upper chest aperture, we chose an alternate access. Clamshell thoracotomy with reverse sternotomy allows central vascular control and excision of large goitres bypassing predictable problems at the cervicothoracic junction. Surgery was performed with minimal blood loss and with excellent functional outcome. The described access adds to the repertoire to deal with this unusual situation.
Department of Endocrine Surgery, King's College Hospital, King's Health Partners, London, UK.
Georgios
G
Komninos
Department of Endocrine Surgery, King's College Hospital, King's Health Partners, London, UK.
Gabriele
G
Galata'
Department of Endocrine Surgery, King's College Hospital, King's Health Partners, London, UK.
Klaus-Martin
KM
Schulte
D006045:Goiter, Substernal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D056346:Sternotomy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*