Cervical Approach for Ectopic Mediastinal Goiter: A Case Report

Abstract

Ectopic mediastinal goiter (EMG) is an unusual condition where thyroid tissue develops in the mediastinum instead of its usual location in the neck. Diagnosing EMG can be challenging, as it represents only a small fraction of all mediastinal tumors. Management typically involves a sternotomy or other thoracic approaches; however, a cervical approach may be considered in select cases. We report the case of a 65-year-old woman who was admitted following the incidental discovery of an anterior mediastinal mass on chest CT. The mass displayed imaging characteristics similar to thyroid tissue but appeared independent of the cervical thyroid gland. Surgical removal was successfully performed via a cervical approach, and histopathological analysis confirmed the diagnosis of an ectopic colloid goiter. EMG is distinct from secondary retrosternal goiters due to the lack of continuity with the cervical thyroid. It is often asymptomatic but may present with compressive symptoms depending on its size and location. Imaging studies play a key role in diagnosis, although differentiating EMG from other mediastinal masses can be difficult. Surgical excision is generally required to prevent compressive complications. While sternotomy and thoracic approaches remain standard, our case - and others in the literature - demonstrates that a cervical approach with meticulous dissection may be sufficient, particularly for masses located in the anterior or superior mediastinum. EMG should be considered in the differential diagnosis of mediastinal masses, and a cervical approach offers a less invasive alternative for appropriately selected patients.