PMC9343975_01
Computed tomography imaging two months before resection. (A) Multinodular thyroid gland measuring 14.6x6.1x14.5 cm3. (B) Heterogeneous nodule (measuring 3.2x4.0x4.7 cm3) along the right paratracheal station initially thought to be related to the goiter.
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Computed tomography imaging of the neck and chest showed a markedly enlarged multinodular thyroid gland (14.6x6.1x14.5 cm3) with extension into the mediastinum and a heterogeneous nodule (3.2x4.0x4.7 cm3) just inferior but adjacent to the presumed thyroid mass (Figure 1).
Intraoperative thoracoscopic photographs. (A) Blue arrow marking goiter. Black arrow marking superior vena cava. Black star marking lymph node. Red arrow marking right internal mammary artery. Green arrow marking azygos vein. (B) Blue arrow marking goiter. Black arrow marking lymph node. Green circle marking azygos vein.
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This necrotic right paratracheal lymph node in the 4R location was meticulously completely dissected off the aorta, superior vena cava, and trachea using a combination of blunt and electrocautery dissection (Figure 2).