Vol.:(0123456789) 1 3 General Thoracic and Cardiovascular Surgery (2020) 68:1051–1054 https://doi.org/10.1007/s11748-019-01211-6 CASE REPORT Intrapericardial goiter Gökhan Kocaman 1  · Bülent Mustafa Yenigün 1  · Ayşegül Gürsoy Çoruh 2  · Emre Muhammed Koçak 1  · İlyas Memmedyarow 3  · Merve Tural 4  · Serpil Dizbay Sak 4  · Levent Yazıcıoğlu 3  · Rıfat Murat Akal 1 Received: 27 July 2019 / Accepted: 13 September 2019 / Published online: 3 October 2019 © The Japanese Association for Thoracic Surgery 2019 Abstract Intrapericardial goiter cases are only a few in the literature. We present a 53-year-old woman who was operated for 8-cm anterior mediastinal mass located completely intrapericardial and histopathological examination revealed an ectopic goiter. It may be difcult to distinguish between mediastinal masses within or outside the pericardium. Thoracoscopy may be needed in such cases. Keywords Ectopic goiter · Intrathoracic goiter · Intrapericardial goiter · Ectopic thyroid Introduction Ectopic intrathoracic goiter is a rare tumor. Intrapericardial goiter cases are only a few in the literature. This condition is thought to occur due to the abnormal migration of thyroid tissue in the embryological period [1]. We present an adult case who was operated successfully. Case A 53-year-old female patient was admitted to the hospi- tal with complaints of chest and back pain not exceeding 1 month. Thoracic computed tomography (CT) revealed an 8-cm smooth contoured mass in the anterior mediastinum. The mass had a SUVmax of 3.6 in PET/CT. The patient was referred to our clinic. She had no pathological fndings in her physical examination. The patient had a history of total thyroidectomy due to nodular goiter in 2010 and use of levothyroxine sodium since 2010. Levothyroxine was dis- continued in the patient who had high T3 and T4 levels and supressed TSH levels. After 2 weeks, T3 and T4 levels did not decrease and thyroid scintigraphy revealed no uptake in the neck or anterior mediastinal lesion. The patient was started on 2 × 5 mg methimazole tablet due to thyrotoxicosis. In the anteroposterior chest X-ray, opacity was observed to remove the right heart shadow. Renewed CT examination was performed. Axial CT images demonstrated a well-cir- cumscribed round mass with a diameter of 82 × 51 × 68 mm (T × AP × CC) on the right anterior mediastinum which is adjacent to ascending aorta. This solid hypodense mass con- tained amorphous calcifcations. The mean attenuation value was measured as 84 Hounsfeld Unit (HU). On axial and sag- ittal, coronal reconstructed images, the lesion was thought to be a mediastinal mass with pericardial invasion (Fig. 1). The lesion compressed the right auricle of heart but there was no sign of myocardial invasion on CT. We diagnosed the mass as thymoma or ectopic mediastinal goiter and biopsy was not planned because complete resection of the mass seemed pos- sible. The patient was prepared for video-assisted thoraco- scopic surgery (VATS). After evaluating the mass as totally intrapericardial with thoracoscopy, the operation was termi- nated because we thought it might be a cardiac tumor such as rhabdomyoma, myxoma or a teratoma having supplies from coronary arteries. Median sternotomy with the cardiovas- cular surgery team (CVS) was planned for another session. The patient was transferred to the CVS clinic and transtho- racic echocardiography was performed. As a result, valve * Gökhan Kocaman gkhnkcmn@hotmail.com 1 Thoracic Surgery Department, Faculty İbn-I Sina Hospital, Ankara University School of Medicine, 06100 Sıhhiye, Ankara, Turkey 2 Radiology Department, Ankara University School of Medicine, Ankara, Turkey 3 Cardiovascular Surgery Department, Ankara University School of Medicine, Ankara, Turkey 4 Medical Pathology Department, Ankara University School of Medicine, Ankara, Turkey