Fig. 23.39b
 Intrathoracic goitre in acromegaly.
 The right lateral view  shows a clearly defined mass lying posteriory. The patient had presented with a goitre and had noticed some enlargement of the hands and feet. There were no symptoms of dysphagia or of thyrotoxicosis. The mass in the chest was subsequently shown on T scans to be in continuity with the cervical goitre. The patient was also found to have a pituitary tumour and acromegaly. Prominent muscle insertions can be seen on the PA chest film at the lower borders of the ribs but no bony changes of acromegaly are present in the dorsal spine (see Fig. 23.7). At the combined surgical approach of cervical incision and a right posterolateral thoractomy, the large mass in the right side of the mediastinum was confirmed to be continuous with an enlarged right lobe of the thyroid gland and was removed. Histological examination showed that the mass was a large colloid goitre.