Tracheal varices caused by mediastinal compression of a large intrathoracic goiter: report of a case

• Published in: Il Giornale di chirurgia 2015-01, Vol.36 (1), p.26-28
• Main Authors: Lucchini, R, Santoprete, S, Triola, R, Polistena, A, Monacelli, M, Avenia, S, Sanguinetti, A, Puma, F, Avenia, N
• Format: Article
• Language: English
• Subjects: Clinical Practice; Goiter, Substernal - complications; Goiter, Substernal - surgery; Hemoptysis - etiology; Humans; Male; Middle Aged; Sternum - surgery; Thyroidectomy - methods; Trachea - blood supply; Treatment Outcome; Varicose Veins - complications; Varicose Veins - etiology
• ISSN: 0391-9005; 1971-145X
• DOI: 10.11138/gchir/2015.36.1.026

Tracheal varices are a rare condition but they can be an important source of massive or recurrent haemoptysis. Usually they are related to increased pressure in the pulmonary veins. Mediastinal goiter is often associated to compressive effects on the surrounding structures, including mediastinal vessels with potential superior vena cava syndrome. We describe a case, not previously reported in literature, of mediastinal goiter with hemoptysis as first clinical manifestation. Bleeding was attributed to a superior vena cava syndrome associated to a tracheal fragile mucosa with an easily bleeding intramural nodule which was diagnosed as tracheal varices after total thyroidectomy. The nodule in fact disappeared together with the venous hypertensive signs after venous decompression of the mediastinum. Compressive symptoms including tracheal varices, related to mediastinal goiter, can be treated surgically by total thyroidectomy via cervicotomy and when required with associated median sternotomy.