Retrotracheal goiter: a diagnostic and therapeutic problem.

A patient with chronic cough and recent dysphagia was found to have a retrotracheal mass extending into the visceral mediastinum on chest roentgenogram. A computed tomographic scan confirmed a retrotracheal lesion, which was believed to be of lymphatic origin. A thyroid scan demonstrated downward displacement of the left lobe but little uptake in the mass. Histological findings of mediastinal biopsies were inconclusive. A large retrotracheal thyroid adenoma was easily excised through a right thoracotomy. The approach to diagnosis and, in cases of doubt, the safety of surgical access through thoracotomy for thyroid lesions in this unusual site is discussed.

Villous adenoma of the large bowel; benign and malignant.

The radiological appearances on double contrast barium enema examination of 14 cases of villous adenoma are described and illustrated. Problems of diagnosis and detection of malignancy are discussed. It is concluded that in the majority of cases a confident radiological assessment of benignancy or malignancy cannot be made. The importance of villous adenoma as a pre-cancerous condition and the high incidence of associated large bowel carcinoma are emphasized.

Ultrasound and dissection of the abdominal aorta.

Ultrasonography is a useful non-invasive tool in the diagnosis of aortic dissection involving the abdominal aorta. Three cases are described in which the diagnosis of aortic dissection was established by ultrasound examination. Some of the pitfalls of contrast aortography are demonstrated and the importance of obtaining ultrasound scans in both the longitudinal and transverse planes is emphasised.