11. A 67-year-old woman presented with a 6-month history of dyspnea and dysphagia. Physical examination
revealed a small cervical goiter, but the lower poles of the thyroid were not palpable. The serum thyrotropin
and free thyroxine levels were normal. Ultrasonography of the neck revealed a large goiter with the right lobe
extending into the anterior superior mediastinum; the lower part of the mass was not detectable because of
the sternum. Chest radiography (Panel A) showed tracheal deviation (arrows). Cervical and mediastinal
computed tomography (Panels B and C, respectively) showed a large goiter (8 by 6 by 10 cm) extending from
the laryngeal cartilage into the mediastinum, displacing vascular structures (black arrows) and causing both
compression and deviation of the trachea (white arrows). Total thyroidectomy was performed, and histologic
examination revealed a multinodular goiter. The patient's symptoms resolved after surgery.
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19. Figure 1 Photographs of the patient showing the reduction in swelling of the
face, neck and upper extremities
Chee CE et al. (2007) Superior vena cava syndrome: an increasingly frequent complication
of cardiac procedures
Nat Clin Pract Cardiovasc Med 4: 226–230 doi:10.1038/ncpcardio0850
