Substernal goiter: an unusual cause of respiratory failure after coronary artery bypass grafting.

Substernal goiter can cause extrathoracic upper airway obstruction. Since cardiopulmonary bypass results in a systemic inflammatory response syndrome characterized by an increase in capillary permeability and edematous changes in many tissues including the thyroid gland, an existing nonobstructive substernal goiter may become obstructive postoperatively. We describe the case of a patient with an asymptomatic substernal goiter who required urgent thyroidectomy for tracheal obstruction after elective coronary artery bypass grafting. To the best of our knowledge, ours is the 1st such case reported in the English-language medical literature. This case illustrates that, in cases of acute postoperative respiratory failure after open heart surgery, tracheal obstruction caused by enlarged substernal goiter should be considered in the differential diagnosis.