images in clinical medicine

Th e n e w e ng l a nd j o u r na l o f m e dic i n e

n engl j med 356;26 www.nejm.org june 28, 2007 e27

A72-year-old woman presented for evaluation of dyspnea. thirty-fiveyearsearlier,shehadnoticedapainless,slowlyenlarginganteriorneckmass.Sinceshewasotherwiseasymptomaticandmanyinhercommunityhadthesameproblem,shedidnotseekmedicalattention.Forthepastfewyears,however,shehashadasensationofsuffocatingafewminutesafterfallingasleep.Physicalexaminationshowedagoiterthatwaslarge,lobular,soft,andpainless,withcyanosisandprotrusionoftheinferiorlip(PanelA),whichwasprobablyrelatedtochronicrespiratoryinsufficiency.Serumthyrotropinandfreethyroxinelevelswerenormal.Computedtomography(PanelB)revealedaheterogeneousgoiter,16cmby7cm,thatwasincontactwiththetrachea(arrow)andwasdisplacingvascularstruc-tures(arrowheads).Cytologicexaminationofaspecimenobtainedbyaspirationshowedacolloidgoiter.Surgicaltreatmentwassuccessfullyaccomplishedearlyin2007.Copyright 2007 Massachusetts Medical Society.

EndemicMultinodularGoiter

Daniel Cuevas-Ramos, M.D. Bernardo Prez-Enrquez, M.D.

Instituto Nacional de Ciencias Mdicas y Nutricin Salvador Zubirn Mexico City, Mexico shiverqks@hotmail.com

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