Large goiters can compress the trachea, esophagus, and thoracic vasculature (
1
,
2
). 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 (
3
), 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 (
5
). 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 (
6
), thyroidectomy (
5
), 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 (
7
), superior vena cava obstruction (
8
), and constrictive pericarditis.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Retrosternal goiter.Chest. 1995; 108: 78-82
- Substernal goiter.Am J Otolaryngol. 1994; 15: 409-416
- Fatal haematemesis due to benign retrosternal goiter.Postgrad Med J. 1992; 68: 756-757
- The lipoprotein profile of chylous and nonchylous pleural effusions.Mayo Clin Proc. 1980; 55: 700-704
- Chylothorax.Ann Thorac Surg. 1971; 12: 527-550
- Lymphatic drainage system after left radical neck dissection.Ann Otol Rhinol Laryngol. 1994; 103: 46-48
- Chylothorax.Am J Clin Oncol. 1996; 19: 99-101
- Chylothorax secondary to obstruction of the superior vena cava.Thorax. 1990; 45: 978-979
- Primary chylopericardium.Ann Thorac Surg. 1994; 58: 262-266
- Combined chylopericardium and chylothorax after total correction of Fallot’s tetralogy.Thorac Cardiovasc Surg. 1984; 32: 115-116
- Combined chylothorax, chylopericardium, and cranial vena cava syndrome in a dog with thymoma.J Am Vet Med Assoc. 1990; 197: 1354-1356
- Simultaneous idiopathic chylopericardium and chylothorax.South Med J. 1981; 74: 357-359
- Retrosternal goiter associated with chylothorax.Chest. 1994; 106: 1924-1925
- Retrosternal goiter and chylothorax.Respiration. 1986; 50: 70-71
- Chylothorax due to toxic thyroid adenoma.Proc Roy Soc Med. 1964; 57: 1131-1132
- Management of substernal goiters.J Otolaryngol. 1992; 21: 165-170
- Intra-thoracic goiter.Surg Gynecol Obstet. 1934; 59: 627-637
- Comparison of placebo with l-thyroxine alone or with carbimazole for treatment of sporadic non-toxic goitre.Lancet. 1990; 336: 193-197
- Substernal goiter.J Surg Oncol. 1995; 60: 207-212
- Management of patients with substernal goiters.Surg Clin North Am. 1995; 75: 377-394
- Iodine-induced thyrotoxicosis.Medicine. 1983; 62: 1-20
- Large compressive goiters treated with radioactive iodine.Ann Intern Med. 1994; 121: 757-762
- I-131-treatment of nodular non-toxic goitre.Eur J Endocrinol. 1996; 134: 15-20
- 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
- Long term changes in nodular goiter.J Clin Endocrinol Metab. 1998; 83: 780-783
Article info
Publication history
Published online: August 16, 2004
Accepted:
May 19,
1998
Received in revised form:
May 19,
1998
Received:
November 26,
1997
Identification
Copyright
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
User license
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) | How you can reuse 
Elsevier's open access license policy
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)
Permitted
For non-commercial purposes:
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article (private use only, not for distribution)
- Reuse portions or extracts from the article in other works
Not Permitted
- Sell or re-use for commercial purposes
- Distribute translations or adaptations of the article
Elsevier's open access license policy
