Grigoletto R, Toniato A, Piotto A, Bernante P, Bernardi C, Pagetta C, Pelizzo M R
Istituto di Chirurgia Generale I, Università degli Studi, Padova.
Minerva Chir. 1997 Jul-Aug;52(7-8):943-8.
The forgotten goiter is most often the consequence of the incomplete removal of a "plunging" goiter, but it can sometimes be attributed to a concomitant, unrecognised mediastinal goiter which is not connected to the thyroid. Differential diagnosis must be made with other mediastinal masses and with plunging relapses of a previously operated struma. Radiological analysis of persisting mediastinal involvement before and immediately after surgery is the only decisive means of diagnosis, but this is not always available in practice. In this paper the authors report a case of considerable size observed in a series of 346 mediastinal goiters operated between 1967 and 1994. They examine the pathogenetic aspects and the nosological, diagnostic and therapeutic problems related to forgotten goiter, and lastly they list the recommendations that several surgeons have made in an attempt to reduce the incidence. In conclusion, the systematic use of CAT or NMR in the diagnosis of mediastinal opacity may help to reduce the risk of forgetting glandular residue in the mediastinum.
隐匿性甲状腺肿通常是“坠入性”甲状腺肿切除不完全的后果，但有时也可能归因于同时存在的、未被识别的与甲状腺无关的纵隔甲状腺肿。必须与其他纵隔肿块以及先前手术的甲状腺肿的坠入性复发进行鉴别诊断。手术前后对持续存在的纵隔受累情况进行放射学分析是唯一决定性的诊断方法，但在实际中并非总是可行。本文作者报告了在1967年至1994年间接受手术的346例纵隔甲状腺肿系列中观察到的一例体积较大的病例。他们研究了与隐匿性甲状腺肿相关的发病机制、疾病分类、诊断和治疗问题，最后列出了几位外科医生为降低发病率所提出的建议。总之，在诊断纵隔模糊时系统使用计算机断层扫描（CAT）或核磁共振（NMR）可能有助于降低纵隔内遗漏腺体残余的风险。
