title: Bilateral brachiocephalic vein compression: an unusual and rare presentation of multinodular goitre.
abstract: An interesting and rare case where a longstanding multinodular goitre causes sudden onset symptoms of superior vena cava obstruction. The symptoms were caused by bilateral brachiocephalic vein compression against the first rib. The patient's symptoms included upper limb and facial swelling, whereas her lower limbs were not oedematous (figure 1). The patient underwent CT imaging which showed a multinodular retrosternal thyroid filling the space created by the first rib, sometimes known as the thoracic outlet. The goitre expanded sufficiently to compress the brachiocephalic vein on both sides as shown in figures 2 and 3. This prevented venous drainage from the upper limbs and head. The goitre was also large enough to cause deviation of the trachea although there was no airway compromise. This case is interesting as it is very rare for a benign condition such as a multinodular goitre to cause symptoms of superior vena cava obstruction.
authors.affiliation: Department of Medicine, University of Glasgow School of Medicine, Glasgow, UK.
authors.forename: Caitlin Jane
authors.identifier: http://orcid.org/0000-0002-3490-1080
authors.initials: CJ
authors.lastname: McNeill
authors.affiliation: Department of ENT, Eastbourne District General Hospital, Eastbourne, UK.
authors.forename: Joseph Dalby
authors.initials: JD
authors.lastname: Sinnott
authors.affiliation: Department of Radiology, Eastbourne District General Hospital, Eastbourne, UK.
authors.forename: David
authors.initials: D
authors.lastname: Howlett
mesh_terms: D000369:Aged, 80 and over; D016121:Brachiocephalic Veins / Q000503:physiopathology; D005260:Female; D006044:Goiter, Nodular / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D013479:Superior Vena Cava Syndrome / Q000209:etiology*; D014057:Tomography, X-Ray Computed