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Lymphatic compromise associated with substernal goiter

      Large goiters can compress the trachea, esophagus, and thoracic vasculature (
      • Madjar S.
      • Weissberg D.
      Retrosternal goiter.
      ,
      • Singh B.
      • Lucente F.E.
      • Shaha A.R.
      Substernal goiter a clinical review.
      ). Respiratory symptoms include cough, dyspnea, stridor, wheezing, and even death. Esophageal compression can cause dysphagia and choking. Vascular compromise can result in superior vena cava syndrome, esophageal varices (
      • Parker D.R.
      • el-Shaboury A.H.
      Fatal haematemesis due to benign retrosternal goiter.
      ), and formation of collateral networks. There are also rare reports of lymphatic compromise, a consequence of which is chylothorax, the accumulation of lymphatic fluid within the thorax due to interruption of the thoracic duct. Chylothorax usually presents as a chylous pleural effusion, though chylomediastinum and chylopericardium have been described. Chylous pleural effusions can be divided into three categories: congenital, traumatic, and nontraumatic (
      • Bessone L.N.
      • Ferguson T.B.
      • Burford T.H.
      Chylothorax.
      ). Congenital causes include hypoplasia of the lymphatic system and pulmonary lymphangiectasia. Most cases of traumatic chylous pleural effusions are associated with surgical procedures, such as radical neck dissection (
      • Har-El G.
      • Lucente F.E.
      Lymphatic drainage system after left radical neck dissection.
      ), thyroidectomy (
      • Bessone L.N.
      • Ferguson T.B.
      • Burford T.H.
      Chylothorax.
      ), thymectomy, and esophagogastrectomy. Nontraumatic causes are generally a result of obstruction or erosion of the thoracic duct or its collateral beds. Obstruction can be intrinsic, as in lymphoma and leukemia, or extrinsic as with left subclavian vein thrombosis (
      • Van Veldhuzen P.J.
      • Taylor S.
      Chylothorax a complication of a left subclavian vein thrombosis.
      ), superior vena cava obstruction (
      • Warren H.W.
      • Altman J.S.
      • Gregory S.A.
      Chylothorax secondary to obstruction of the superior vena cava a complication of the Leeven shunt.
      ), and constrictive pericarditis.
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      References

        • Madjar S.
        • Weissberg D.
        Retrosternal goiter.
        Chest. 1995; 108: 78-82
        • Singh B.
        • Lucente F.E.
        • Shaha A.R.
        Substernal goiter.
        Am J Otolaryngol. 1994; 15: 409-416
        • Parker D.R.
        • el-Shaboury A.H.
        Fatal haematemesis due to benign retrosternal goiter.
        Postgrad Med J. 1992; 68: 756-757
        • Staats B.A.
        • Ellefson R.D.
        • Budahn L.L.
        • et al.
        The lipoprotein profile of chylous and nonchylous pleural effusions.
        Mayo Clin Proc. 1980; 55: 700-704
        • Bessone L.N.
        • Ferguson T.B.
        • Burford T.H.
        Chylothorax.
        Ann Thorac Surg. 1971; 12: 527-550
        • Har-El G.
        • Lucente F.E.
        Lymphatic drainage system after left radical neck dissection.
        Ann Otol Rhinol Laryngol. 1994; 103: 46-48
        • Van Veldhuzen P.J.
        • Taylor S.
        Chylothorax.
        Am J Clin Oncol. 1996; 19: 99-101
        • Warren H.W.
        • Altman J.S.
        • Gregory S.A.
        Chylothorax secondary to obstruction of the superior vena cava.
        Thorax. 1990; 45: 978-979
        • Akamatsu H.
        • Amano J.
        • Sakamoto T.
        • Suzuki A.
        Primary chylopericardium.
        Ann Thorac Surg. 1994; 58: 262-266
        • Papaioannou Y.
        • Vomvoyannis A.
        • Andritsakis G.
        Combined chylopericardium and chylothorax after total correction of Fallot’s tetralogy.
        Thorac Cardiovasc Surg. 1984; 32: 115-116
        • Peaston A.E.
        • Church D.B.
        • Allen G.S.
        • Haigh S.
        Combined chylothorax, chylopericardium, and cranial vena cava syndrome in a dog with thymoma.
        J Am Vet Med Assoc. 1990; 197: 1354-1356
        • Torrington K.G.
        • Youkey J.R.
        Simultaneous idiopathic chylopericardium and chylothorax.
        South Med J. 1981; 74: 357-359
        • Delgado C.
        • Martin M.
        • de la Portilla F.
        Retrosternal goiter associated with chylothorax.
        Chest. 1994; 106: 1924-1925
        • Fernandez-Cruz L.
        • Serra-Battles J.
        • Picado C.
        Retrosternal goiter and chylothorax.
        Respiration. 1986; 50: 70-71
        • White A.G.
        Chylothorax due to toxic thyroid adenoma.
        Proc Roy Soc Med. 1964; 57: 1131-1132
        • Wax M.K.
        • Briant D.R.
        Management of substernal goiters.
        J Otolaryngol. 1992; 21: 165-170
        • Lahey F.H.
        • Swinton N.W.
        Intra-thoracic goiter.
        Surg Gynecol Obstet. 1934; 59: 627-637
        • Berghout A.
        • Wiersinga W.M.
        • Drexhage H.A.
        • et al.
        Comparison of placebo with l-thyroxine alone or with carbimazole for treatment of sporadic non-toxic goitre.
        Lancet. 1990; 336: 193-197
        • Newman E.
        • Shaha A.R.
        Substernal goiter.
        J Surg Oncol. 1995; 60: 207-212
        • Mack E.
        Management of patients with substernal goiters.
        Surg Clin North Am. 1995; 75: 377-394
        • Fradkin J.E.
        • Wolff J.
        Iodine-induced thyrotoxicosis.
        Medicine. 1983; 62: 1-20
        • Huysmans D.A.K.C.
        • Hermus A.R.M.M.
        • Corstens F.H.M.
        • et al.
        Large compressive goiters treated with radioactive iodine.
        Ann Intern Med. 1994; 121: 757-762
        • Nygaard B.
        • Faber J.
        • Hegedus L.
        • Hansen J.M.
        I-131-treatment of nodular non-toxic goitre.
        Eur J Endocrinol. 1996; 134: 15-20
        • Celani M.F.
        • Mariani M.
        • Mariani G.
        On the usefulness of levothyroxine suppressive therapy in the medical treatment of benign solitary, solid, or predominantly solid thyroid nodules.
        Acta Endocrinol. 1990; 123: 603-608
        • Papini E.
        • Petrucci L.
        • Guglielmi R.
        • et al.
        Long term changes in nodular goiter.
        J Clin Endocrinol Metab. 1998; 83: 780-783