This patient is a 78 year-old, white female with a history of goiter since 1950. She has been recommended surgery in the past and has refused, but is now seeking this as an option becuase of recent increase in size of the goiter and compomise of her airway. She is currently using supplemental oxygen since January presumably for COPD, and she has had three episodes of pneumonia this past year. There is some question as to whether this is due in some part to her tracheal obstruction. She states that she has no pain or symptoms with the goiter in the past, but that now she feels pressure in her neck.
Past medical and surgical history are noncontibutory.
A review of systems is significant for intermittent angina.
Physical Exam:
| There is a large mass in her neck primarily on the left extending from the angle of the mandible down to her thoracic inlet. The carotid artery on the left is displaced laterally. There is enlargement of the right thyroid lobe. The patient can fully extend her neck and the mass is mobile with deglutition. There is no associated cervical adenopathy. The patient's skin is warm and dry. The rest of her exam is within normal limits. |
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Chest X-Ray:
