case_images: PMC6247568_01
case_images: Chest X-ray findings. The chest X-ray showed a tumor shadow (arrow) in the upper-middle field of the right lung with pleural effusion and a tumor shadow (arrowhead) in the upper field of the left lung.
case_images: CRIS2018-6107982.001.jpg
case_images: PMC6247568_01_CRIS2018-6107982.001.jpg
case_images: fig1
case_images: The chest X-ray showed a tumor shadow in the upper-middle field of the right lung with pleural effusion and a tumor shadow in the upper field of the left lung (Figure 1).
case_images: CT findings. CT of the neck and chest showed diffuse swelling of the thyroid gland and a substernal goiter, which extended to both sides of the thorax. The goiter extended to the bifurcation of the trachea on the dorsal side of the superior vena cava, the innominate vein, the aortic arch, and the ventral side of the trachea. It compressed the trachea in the mediastinum, and the lumen of the trachea measured 6 mm in diameter at its narrowest point (arrow). Pleural effusion was also seen in the right thorax.
case_images: CRIS2018-6107982.002.jpg
case_images: PMC6247568_01_CRIS2018-6107982.002.jpg
case_images: fig2
case_images: CT of the neck and chest (Figure 2) showed the diffusely swollen thyroid gland and a substernal goiter, which extended to both sides of the thorax.
case_images: Surgical findings. As a preparation for the resection of the substernal goiter, the major blood vessels, such as the innominate vein (A), brachiocephalic trunk (B), vena cava superior (C), and left subclavian artery (D), were carefully separated from the substernal goiter, and then thyroidectomy was performed.
case_images: CRIS2018-6107982.003.jpg
case_images: PMC6247568_01_CRIS2018-6107982.003.jpg
case_images: fig3
case_images: As a preparation for the resection of the substernal goiter, the major blood vessels, including the innominate vein, brachiocephalic trunk, superior vena cava, and left subclavian artery, were carefully separated from the substernal goiter, and then thyroidectomy was performed (Figure 3).
case_images: Macroscopic findings. The resected thyroid had multiple nodules. The goiter weighed 614 g, and its dimensions were as follows: width:165 mm, length:160 mm, and thickness:60 mm.
case_images: CRIS2018-6107982.004.jpg
case_images: PMC6247568_01_CRIS2018-6107982.004.jpg
case_images: fig4
case_images: The resected thyroid weighed 614 g (Figure 4).