A 64-year-old woman was admitted to the hospital because of swelling of her right upper limb and neck. She had been pointed out a goiter 30 years before admission and followed at another hospital. Since she had an arteriovenous shunt in the right arm at her 61-year-old of age, her right upper limb and neck swelled gradually.
Chest X-ray film showed a tumor shadow in the superior mediastinum. Magnetic resonance imaging revealed a narrow right jugular vein, which was remarkably compressed by the goiter, with stagnation of bloodstream. The patient was diagnosed as having a giant intramediastinal goiter with superior vena caval syndrome. Nearly total thyroidectomy was performed. The pathological diagnosis was adenomatous goiter. After the operation, the swelling of the right upper limb and neck disappeared.
Malignant lung cancers account for most cases of superior vena caval syndrome, but on the other hand, thyroid disease account for rare cases. In this case the increase in venous pressure by the arteriovenous shunt might take part in casing the disease, too. We must also take into consideration the thyroid disease in making an arteriovenous shunt.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)