A 55-year-old woman has a large multinodular goitre with extension into the superior mediastinum causing mild tracheal compression. CT confirms that more than half the gland lies below the thoracic inlet. The most common route of surgical removal is:

• A Median sternotomy
• B Video-assisted thoracoscopic excision
• C Right posterolateral thoracotomy
• D Transcervical collar incision with mobilisation and delivery of the mediastinal component ✓

Explanation

Over 95 percent of mediastinal goitres are extensions of a cervical goitre whose blood supply comes from the inferior thyroid artery in the neck. Delivering the gland through a standard collar incision after mobilising it from its capsular plane succeeds in the vast majority, so sternotomy is reserved for the rare truly ectopic mediastinal goitre supplied by intrathoracic vessels. Thoracotomy approaches are almost never required and add morbidity.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.