Obstruction of the thoracic inlet may be caused by retroclavicular entrapment of a large benign goiter. Flexion of the neck or elevation of the arms may wedge the goiter, much as a cork is inserted into the neck of a bottle, and lead to facial plethora, bulging neck veins, hoarseness, and respiratory embarrassment. Graves disease, autonomous adenoma, Hashimoto thyroiditis, endemic goiter, nodular goiter, or hemorrhage may be responsible. Hyperextending the neck and lowering the arms may offer temporary relief, but surgery may be required to reestablish a patent airway.
Blum M, Biller BJ, Bergman DA. The Thyroid Cork: Obstruction of the Thoracic Inlet Due to Retroclavicular Goiter. JAMA. 1974;227(2):189–191. doi:10.1001/jama.1974.03230150041013
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