interesting thyroid

not the greatest picture, but i took it with my cell phone. massive thyroids seem to be the order of the day. this lady's supposed "asthma" got so bad they had to intubate her. on the ct note the retrosternal mass totally displacing the trachea and esophagus. note the aorta arch as well as the superior vena cava.

i'm thinking sternotomy, but i'm open to suggestions.

two heads are better than one?

this is a patient i have at the moment. i plan on operating as soon as the consultant anaesthetist sees his way clear to dope her. this is not too unusual in south africa. it shows a tendency to wait a long time before seeking help. this next photo will show something that south african doctors will immediately recognise, but may need a note to explain to our international audience. roughly in the middle of the mass are two small parallell scars. these are markings made by a sangoma. they are meant to be therapeutic. as you can see they were not. i have already posted about that (here and here) so i will not labour the point any more.

but, if there is any sage advice from surgeons out there for when i do attack this lady with my blade, i'm open to any suggestions. after all, two heads are better than one (except of course in the case above)