An x-ray may be helpful in the diagnosis of multinodular goiter. Findings on an x-ray suggestive of multinodular goiter include anterior/superior mediastinal mass, that may be associated with deviation of the trachea and/or cervicothoracic sign.

An x-ray may be helpful in the diagnosis of multinodular goiter. Findings on an x-ray suggestive of multinodular goiter include:^[1]

• Anterior/superior mediastinal mass, that may be associated with deviation of the trachea.
• Cervicothoracic sign: Cervicothoracic sign is used to localize a mass in the superior mediastinum on frontal chest x-ray as either anterior or posterior. Anterior mediastinum ends at the level of the clavicles, Any mass with an upper border above the level of clavicles must be located posteriorly in the chest, i.e. apical segments of upper lobes, pleura, or posterior mediastinum.

• In this case the multinodular goitre is so enlarged it extends into the superior mediastinum, resulting in the cervicothoracic sign.
• Widening of the superior mediastinal contours, which extend superior to the thoracic outlet.Tracheal deviation to the left at the level of the thoracic outlet. This is suspicious for a thyroid mass with retrosternal extension.