ABSTRACT
BACKGROUND: Mediastinal goitres are rare and may be diagnosed late since they are likely to manifest with non-specific cardiorespiratory symptoms especially when there is no visible cervical component. The imaging modality of choice is a contrast-enhanced computed tomography (CT) scan of the neck and chest after incidental finding of goitre on chest X-ray indicated for a condition unrelated to goitre. METHODS: This case series aims to highlight the peculiarity of mediastinal goitre in terms of clinical presentation, surgical approach, airway challenges at anaesthesia, specific complications and final histopathological report. RESULTS: Over a nine-year period, four cases of euthyroid mediastinal goitre underwent sternotomy. The mean age was 57.5 years (45-71) and all patients were female. Most patients presented with non-specific cardiorespiratory symptoms. The difficult airway set was used in all cases and there were two instances of damage to the recurrent laryngeal nerve (RLN). All histopathological reports were benign. CONCLUSION: The presentation of the mediastinal goitres was atypical. Cervical incision and sternotomy were performed in all cases. There were two instances of RLN injury and no malignant histopathology. Despite the potential threat to the airway, all intubations were uneventful.
Subject(s)
Anesthesia , Goiter , Female , Humans , Male , Middle Aged , South Africa , AgedABSTRACT
BACKGROUND: Presentation of hyperparathyroidism varies and is highly non-specific. The automated calcium analyzer has made the diagnosis easy. Similarly, the advent of Sestamibi scan has paved the way to minimally invasive parathyroidectomy indicated for parathyroid adenoma. There is no uniformity in the extent of minimally invasive parathyroidectomy that is done through limited incision under radio or sonar guidance and endoscopically. In this study, we are presenting the focused parathyroidectomy performed under sonar guidance and superficial cervical block (SCB). The prerequisite is concordant preoperative Sestamibi and ultrasound imaging. METHOD: A two-year review of parathyroidectomies performed between January 2013 and December 2014. OBJECTIVE: To reflect on the result of sonar-guided focused parathyroidectomy under SCB. RESULTS: There was good correlation between the pre-operative imaging, the intra-operative findings and the postoperative histology result of the 15 cases analysed. CONCLUSION: The focused parathyroidectomy under SCB yielded a good result with concordant preoperative Sestamibi and ultrasound findings.
Subject(s)
Adenoma/surgery , Cervical Plexus Block/methods , Hyperparathyroidism/surgery , Parathyroid Neoplasms/surgery , Parathyroidectomy/methods , Ultrasonography, Doppler/methods , Adenoma/diagnostic imaging , Adult , Aged , Cohort Studies , Female , Humans , Hyperparathyroidism/diagnostic imaging , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Monitoring, Intraoperative/methods , Parathyroid Neoplasms/diagnostic imaging , Preoperative Care/methods , Prognosis , Retrospective Studies , South Africa , Surgery, Computer-Assisted/methods , Technetium Tc 99m Sestamibi , Treatment OutcomeABSTRACT
Introduction: Presentation of hyperparathyroidism varies and is highly non-specific.The automated calcium analyzer has made the diagnosis easy. Similarly, the advent of Sestamibi scan has paved the way to minimally invasive parathyroidectomy indicated for parathyroid adenoma. There is no uniformity in the extent of minimally invasive parathyroidectomy that is done through limited incision under radio or sonar guidance and endoscopically. In this study, we are presenting the focused parathyroidectomy performed under sonar guidance and superficial cervical block (SCB). The prerequisite is concordant preoperative Sestamibi and ultrasound imaging.Objective: To reflect on the result of sonar-guided focused parathyroidectomy under SCB.Method: A two-year review of parathyroidectomies performed between January 2013 and December 2014.Result: There was good correlation between the pre-operative imaging, the intra-operative findings and the postoperative histology result of the 15 cases analysed. Conclusion: The focused parathyroidectomy under SCB yielded a good result with concordant preoperative Sestamibi and ultrasound findings
