Fig. 23.39a Intrathoracic goitre in acromegaly. The PA chest film shows a large mass in the right upper chest which is confluent with the mediastinum medially and has a well-defined lateral margin. The mass does not contain any obvious calcification and is only slightly displacing the trachea to the left. The right lateral view (b) 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).
