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X-ray Diagnosis and Therapy of Thyroid Disease 1 John Remer , M.D. and Webster W. Belden , M.D. New York Hospital, New York City ↵ 1 Read before the Radiological Society of North America at the Fourteenth Annual Meeting, at Chicago, Dec. 3–7, 1928. Excerpt THE rôle of roentgen rays in the diagnosis of thyroid disease, though limited, is nevertheless an indispensable one in establishing the diagnosis of a substernal extension of the thyroid into the superior mediastinum, and therefore a routine X-ray examination of the chest should be done in all thyroid cases. The bulging in the cervical region is clearly visualized by the X-rays, but there is nothing diagnostic about the shadow which can in any way assist in the diagnosis nor supplement the physical findings of palpation and inspection, except to indicate whether calcification is present in the gland. One must, however, stress the importance of a routine examination of the thorax to rule out a substernal extension. Such routine examinations are done at the New York Hospital by request of both surgical divisions before operation is attempted. When a substernal extension of the thyroid is present, the shadow cast by the roentgen rays is characteristic. The shadow is usually, though not always, bilateral and symmetrical, and is triangular in shape. The base of the triangle is upward, in the root of the neck, and can often be seen to be continuous with the shadow of the enlarged thyroid in the neck. The apex is directed downward, usually merging with the shadow of the aortic arch. The lateral margins are smooth in outline, clear-cut, and stand out sharply against the lung tissue. A most characteristic finding is a displacement of the trachea—forward or to either side. Not infrequently the lumen of the trachea is narrowed. It is well to bear in mind that the hypertrophy of the thyroid may be entirely substernal, with no appreciable thyroid enlargement in the neck. For this reason, if for no other, all cases with symptoms of exophthalmic goiter or toxic adenoma should have a radiographic examination of the thorax. The differential diagnosis is usually not particularly difficult as the pathological conditions occurring in the superior mediastinum in this region are not numerous. Aneurysm of the aorta can usually be easily differentiated in that it is not bilateral and symmetrical and also is situated lower in the thorax. Further, on fluoroscopic examination the aneurysm can be seen to pulsate, whereas the thyroid shadow does not pulsate. Thymus .—An enlarged or persistent thymus may be differentiated by the fact that, although it too is triangular, the triangle is in the reverse position to the triangular shadow of the thyroid; that is, the apex is directed upward and the wide base downward, merging with the shadow of the base of the heart. The thymus shadow is frequently referred to as being keystone-shaped and fitting down over the base of the heart like a cap. It is very rare to encounter any appreciable shadow of a thymus in an adult, despite the fact that in numerous cases of toxic goiter hyperplasia of the thymus is present. Hodgkin's Disease . Copyrighted by the Radiological Society of North America
Radiology – Radiological Society of North America, Inc.
Published: Feb 1, 1930
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