Can a mediastinal goiter be diagnosed with a CT scan?

The article was consulted by Specialist Doctor I Nguyen Thanh Hai - Doctor of Radiology - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International Hospital

CT scan of the neck and chest is the method of choice to evaluate mediastinal goiter. On CT scan, there is a heterogeneous mass, well-defined border, continuous with goiter, high CT attenuation before contrast injection and sharply increased after injection, calcification may be in the form of dots, cluster, arc.

Mediastinal shunting goiter usually presents as an anterior mediastinal mass. In some cases, an enlarged thyroid gland can be palpable in the neck. A highly effective test for the diagnosis of mediastinal prolapse is a contrast-enhanced chest CT scan.
Computed tomography (computed tomography/CT scan) features of the described mediastinal goiter include:
Well defined border There is clear continuity with the goiter in the neck High CT Con before contrast injection, greater than the attenuation of the adjacent muscle. The intensity increases sharply after intravenous contrast injection. Calcification can be in the form of nodules, clusters, and arcs. Some areas do not absorb contrast and have low attenuation. Mediastinal prolapse goiter is often associated with vascular structures in the superior mediastinum.
For a long time, noninvasive methods have been used to evaluate mediastinal mass, with varying degrees of success. Initially, lateral thoracic radiographs and computed tomography are usually indicated to determine the size, location, and density of mediastinal masses, as well as to detect homogeneity and the presence of calcifications. of them. Later, the advent of CT scan increased the ability to diagnose mediastinal mass, providing valuable diagnostic information. Many studies have demonstrated the role of computed tomography techniques in the assessment of mediastinal mass.
In recent years, our country has begun to widely use computed tomography method in diagnosing thoracic diseases in general and mediastinal tumors in particular.

2.1. Frequency and Clinical Manifestations It was previously believed that goiter tends to originate from the lower border of the thyroid gland and diffuse into the anterior mediastinum, but sometimes also occurs posteriorly to the trachea. Furthermore, there have also been reports of goiter appearing in the posterior mediastinum. Loose goiters are usually asymptomatic (13%) and can be detected on routine chest x-ray. But large goiter can be symptomatic (87%), causing: dyspnea (28%), hoarseness, difficulty swallowing (33%), even ischemic heart syndrome. One study found that women are more affected than men, the average age of patients is between 40 and 77 years old. Most patients present with symptoms at examination, mainly detecting goiter in the neck, chest pain and shortness of breath. A few cases (8%) had undergone previous thyroidectomy.
2.2. Features on CT Scan Film Compared with the characteristics when examining goiter by CT scan image as mentioned, other studies also found:
Anterior mediastinal position Even tumor border Clear border around Calcification of high density without contrast injection Concentration of enhancement after intravenous contrast injection There is continuity with goiter in the neck Thus, the results of these studies are consistent with previous findings this.

Mediastinal loop goiter accounts for a small percentage of goiter cases. Most can be easily cut through the neckline. However, there are also cases where the tumor is adherent and protrudes into the posterior mediastinum, requiring combined thoracotomy or sternotomy. There are still many difficulties and complications associated with mediastinal goiter surgery, more complications than conventional thyroidectomy.
Most experts believe that the choice of incision is mainly based on contrast-enhanced CT scan of the chest. This technique helps to assess the depth of the goiter and differentiate the types of goiter. In case of goiter in the thorax, the choice of splitting the sternum or opening the chest. The CT scan method also helps assess the extent of invasion, compression or displacement of the trachea, helps anesthesiologists predict the difficulty of intubation, and helps surgeons predict the possibility of tracheal intubation. tracheostomy after surgery.
Currently Vinmec International General Hospital has a screening service to help check thyroid function and early detect common thyroid diseases such as simple goiter, hyperthyroidism, hypothyroidism, thyroiditis , thyroid nodules, thyroid cancer... so that timely intervention measures can be taken. Early diagnosis and treatment always bring the best recovery results for patients.
Vinmec International General Hospital always has a team of qualified doctors, many years of experience in the profession, applying and modern equipment to the examination, so customers can rest assured and quality medical quality in the hospital.