Case history
In 1994 a 44-yr-old male was admitted for surgical resection of a hard, not painful, nodule which was believed to originate from the isthmus of the thyroid gland. He was known to have mild asthma, treated with inhaled corticosteroids and short-acting β2-agonists. His medical record revealed a smoking history of 20 pack-yrs. The patient denied any other symptoms, except the presence of the nodule.
On physical examination a hard nodule was felt anteriorly to the trachea. A clear separation with the thyroid gland could not be made.
A preoperative computed tomography (CT) scan of the neck revealed a calcified nodule on the midline, adjacent to the trachea (fig. 1⇓). Laboratory studies demonstrated a euthyroid status.
During surgery, the nodule could not be separated from the tracheal cartilaginous ring and a left hemithyroidectomy, with resection of part of the affected cartilaginous ring, was carried out (histology of the nodule in fig. 2a⇓). The tracheal defect was closed with a muscle flap. The patient continued to do well on follow-up examinations ≤5 yrs postoperatively, without complaints. …