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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.

A clean large bowel is a prerequisite for successful barum enema examination. Since the method of whole gut irrigation has been claimed to be very effective and convenient in preparing the colon for surgery, it was thought that it would be interesting to assess its efficacy in the preparation of the bowel for double contrast barium enema examination. Twenty outpatients of similar age, sex distribution, and symptomatology presenting for barium enema examination by a modification of the Malmo double contrast technique were randomly allocated to two groups. The "normal" preparation group ate a restricted diet and took a laxative the day before. Immediately before the examination the colon was washed out using colonic lavage. The "irrigation" group omitted the laxative. The colon was cleansed with warmed isotonic, saline which was infused down a nasogastric tube until the effluent was clear or 10 to 12 liters had been infused. The average amount infused was 10.5 ± 1.1 liters over a mean time of 1.64 ± 0.2 hr. The examinations were performed by one radiologist. Three radiologists (without knowledge of the preparation used) independently assessed all radiographs according to the amount of water and feces remaining, the quality of mucosal coating, the amount of barium present, and terminal ileum filling. When the results of the three radiologists were pooled, mucosal coating and definition were found to be significantly worse in the irrigated patients (P