The finding - tracheal deviation to the left.
The differential - superior mediastinal masses - Thyroid goiter, thyroid malignancy, adenopathy, lymphatic malformation (and cysts), aneurysm, vascular masses (malformations, hemangiomas), Ascending through thoracic inlet - Small Cell, parathyroid mass (uncommon), not commonly listed but I have seen - esophageal cancer.
The most likely diagnosis - far and away the most common is thyroid goiter. This case turned out to be thyroid cancer.
Workup - The first and easiest is history and physical exam. Next may consider ultrasound. Ultrasound can demonstrate the thyroid and find areas of concern and be used for biopsy. If the history and physical exam is inconsistent with thyroid - may consider CT.
The patient had ultrasound which revealed a worrisome lesion. The lesion was biopsied showing thyroid cancer. The patient had surgery and the second image is from an I-123 scan which is used to find areas of residual thyroid and possible metastases. There is normal uptake in the salivary glands and GI tract and 2 foci of uptake in the thyroid bed and a lymph node. The patient is then treated with I-131 which is radioactive Iodine that is taken up by thyroid tissue and then the Iodine radiates it. Patients do remarkably well after the therapy but will have to be on lifetime of thyroid hormone replacement.
references - Primer of Diagnostic Imaging by Weissleder et al.
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