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April 1968

Endothoracic GoiterReport of a Patient Illustrating Diagnostic Problems

Arch Intern Med. 1968;121(4):353-355. doi:10.1001/archinte.1968.03640040047010

While endothoracic goiter commonly presents as an incidental finding on chest x-ray film, it may present as an acute medical emergency due to vascular or tracheal compression. Of particular note in our patient was the sudden onset with severe hypoxia due to airway obstruction, resulting from acute hemorrhage into the goiter.

Patient Summary  A 52-year-old Negro woman was referred with dyspnea and fever. There was a history of pulmonary tuberculosis 20 years previously which was treated by surgical resection. The present history was of fever, cough, and white expectoration of several days duration. Details were not obtainable from the patient due to her stuperous state.Physical examination revealed an acutely ill woman, confused, deeply cyanotic, and dyspneic. Her temperature was 102.4 F (39.1 C); pulse rate, 115 beats per minute; and blood pressure, 150/90 mm Hg. The neck showed marked bilateral superficial jugular vein distension with no visible pulsation. The

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