Dataset Information

Ectopic mediastinal thyroid removed by U-VATS approach. A case report.

ABSTRACT:

Introduction

Ectopic thyroid tissue is a rare entity, and accounts for approximately 1% of all mediastinal tumours. It is a differential diagnosis of the mediastinum tumors or metastatic deposits from an orthotopic gland, as well as other benign or malignant masses. Although most cases are asymptomatic and discovered incidently by imaging, symptoms related to tumor size and its compression of adjacent structures may also appear which necessites explorations and lead to diagnosis.

Case presentation

This is a 59-year-old women, followed for glaucoma and operated for bilateral congenital cataract reffered to our structure by the service of pnemology for a right laterotracheal mediastinal mass. The patient presented respiratory symptoms over four months, and the physical examination found patient in good condition with PS 0 and normal vital signs, a poor oral health was noticed. The CT scann showed a left basal opacity and a right laterotracheal mediastinal mass at the upper right mediastinum, pushing forward the superior vena cava and compressing the trachea on the contralateral side, with well-defined borders and without signs of infiltration of adjacent structure. The brochoscopy was perfomed which showed the yellowish granulous aspect and the pathophysiology revealed a pulmonary actinomycosis. The patient was treated with antibiotic based on parenteral infusion of penicillin G at 20 million / day for 6 weeks relayed by oral administration of 3 g / day for 3 months with a good response and the left basal opacity disappeared on the CT control but the mediastinal mass persisted. After multidisciplinary concertation, the mediastinoscopy was perfomed and has revealed an ectopic thyroid which was removed by Uniportal Videoassisted Thoracoscopic Surgery (U-VATS) approach.

Discussion

The first case of ectopic thyroid gland was described by Hickman in 1869, since a few cases have been reported by the literature. Its prevalence is about 1 per 100?000-300?000 people, rising to 1 per 4000-8000 patients with thyroid disease. The main techniques indicated in the management of undetermined lesions of the anterior mediastinum, are midline exploratory sternotomy, anterior lateral thoracotomy and VATS. U-VATS has demonstrated its feasibility and safety compared to conventional techniques by several advantages.

Conclusion

Ectopic mediastinal thyroid is an unusual presentation of thyroid pathology. Complete surgical resection remains a therapeutic and a key diagnosis. The aim of this study is to prouve the feasibility, efficiency and efficacity of U-VATS approach as minimally invasive thoracic surgery for mediastinal mass resection.

SUBMITTER: El Haj NI

PROVIDER: S-EPMC7776121 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Ectopic mediastinal thyroid removed by U-VATS approach. A case report.

El Haj Najat Id NI Hafidi Sara S Khoaja Ayoub A Boubia Souheil S Karkouri Mehdi M Ridai Mohammed M

International journal of surgery case reports 20201216

<h4>Introduction</h4>Ectopic thyroid tissue is a rare entity, and accounts for approximately 1% of all mediastinal tumours. It is a differential diagnosis of the mediastinum tumors or metastatic deposits from an orthotopic gland, as well as other benign or malignant masses. Although most cases are asymptomatic and discovered incidently by imaging, symptoms related to tumor size and its compression of adjacent structures may also appear which necessites explorations and lead to diagnosis.<h4>Case ...[more]

PMID: 33373924

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Project description:BackgroundPericardiocentesis is an effective treatment for cardiac tamponade, but there are risks, including haemorrhagic events, cardiac perforation, pneumothorax, arrhythmia, acute pulmonary oedema and so on. Mediastinal effusion caused by puncture is rarely reported.Case presentationA 47-year-old man who had a history of right leg deep vein thrombosis and pulmonary artery embolism with implantation of an inferior vena cava filter presented for inferior vena cava filter removal. Within 30 min after the procedure, he developed chest pain, nausea, vomiting and presyncope with shock. Echocardiography confirmed massive pericardial effusion with evidence of cardiac tamponade. Emergency pericardiocentesis was performed. Confusingly, only 3 mL of bloody pericardial effusion was drained in total, and subsequently, the patient's symptoms rapidly improved with stable haemodynamics. Repeat echocardiography showed that the pericardial effusion had disappeared. Urgent computed tomography pulmonary angiography demonstrated localized effusion, which was not seen the previous computed tomography results and was noted around the left ventricle in the mediastinal apace. No intervention was performed, given that there was no bleeding tendency or further adverse events related to the mediastinal effusion. The patient was subsequently discharged in a stable condition a few days later, and outpatient follow-up was advised.ConclusionsMediastinal effusion is a rare complication of pericardiocentesis. In the case described herein, the most likely cause was pericardial effusion extravasated into the mediastinum through the needle insertion site in the puncture process due to large pressure variations in the intrapericardial space with tamponade, differing from cases of over-anticoagulation reported in the previous literature. Just as our case demonstrates that conservative treatment of an hemodynamic insignificant mediastinal effusion may be appropriate. Echocardiography is useful and effective to minimize complication rates.

Dataset Information

Ectopic mediastinal thyroid removed by U-VATS approach. A case report.

Introduction

Case presentation

Discussion

Conclusion

Publications

Ectopic mediastinal thyroid removed by U-VATS approach. A case report.

Similar Datasets

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