Late manifestation of SVC obstruction syndrome and tracheal compression
in our patient can be attributed to cephalad extension of mediastinal tumour.6 For such cervico-thoracic masses, the surgical excision approach is median sternotomy along with neck exploration.9 Tumour adherent to pericardium or pleura should be dealt with meticulously, however literature supports subtotal resection of benign teratomas in order to preserve nearby viscera has shown excellent outcomes.6
Patients with retrosternal goiter radiological findings such as trachea deviations can be seen as well as compressive symptoms such as cough, dyspnea, stridor and dysphagia.12 Tracheal pressure of massive goiters detected in thyroidectomy patients, which constitute a large proportion of surgical patients, is not uncommon.13 In the thyroidectomy series of Sajid et al., 2.68% of patients had clinical and radiological findings of tracheal pressure, and 84% of all patients had radiological evidence of tracheal compression
Short neck, obesity, round back, limited neck extension, enlarged thorax which encroaches on the face, abnormal facial structure, tracheal deviation, and tracheal compression
may all contribute to technical difficulties with intubation in patients with MAS.
Due to the severity of tracheal compression
, the decision was made to perform endotracheal intubation and mechanical ventilation and transfer to the intensive care unit.
Aortopexy can be performed to relieve the extrinsic tracheal compression
but will not address the other issues caused by the mediastinal shift [10, 11].
(14) In some rare cases, SBS has been associated with tracheal compression
and respiratory failure.
Large goiters can cause dysphagia or breathing difficulties due to local oesophageal or tracheal compression
. Thyroid function often becomes more autonomous with increasing age, and may eventually evolve into overt hyperthyroidism.
To reduce the tracheal compression
, the patient was kept in a head-up position and intravenous fluids were restricted.
CT scan of the neck and chest revealed diffuse homogenous enlargement of both thyroid lobes with the gland extending into the mediastinum and causing tracheal compression
Chest X-ray (CXR), Computed Tomography (CT) neck and upper chest were done to all patients and showed variable degrees of tracheal compression
Surgery is the method of choice in patients with obstructive symptoms, given the risk of progressive tracheal compression
Surgical intervention was decided to remove the mass causing tracheal compression
. At bronchoscopy before surgery, tracheal stenosis caused by external tracheal mass was visible without any additional abnormality.