Abstract
Introduction Massive bleeding from the thyroid gland causing airway compromise secondary to indirect neck trauma is rare. Presentation of case An 89-year-old woman was transferred to our emergency department due to anterior neck pain after a traffic accident. She had been propelled forward and struck her head on the front mirror during emergency braking. Airway patency was confirmed at the first contact. Although her vital signs were stable at presentation, she gradually suffered from respiratory distress and severe dyspnea, implying airway compression, therefore requiring endotracheal intubation. Computed tomography (CT) revealed a large, encapsulated hematoma in the left thyroid gland lobe extending to the upper mediastinum. Contrast-enhanced CT demonstrated an extravasation of the contrast agent around the left superior thyroid artery. The left thyroid artery was ligated and the hematoma was removed immediately. She had a favorable course without further complications and was discharged 36 days after admission. Discussion Airway management is the most important consideration in patients with thyroid injury. Treatment should be customized depending on the degree of respiratory distress resulting from of either involvement of the direct airway or secondary compression. Conclusion Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.
| Original language | English |
|---|---|
| Pages (from-to) | 217-220 |
| Number of pages | 4 |
| Journal | International Journal of Surgery Case Reports |
| Volume | 26 |
| DOIs | |
| Publication status | Published - 2016 |
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Keywords
- Airway distress
- Blunt trauma
- Soft tissue hematoma
- Thyroid artery
ASJC Scopus subject areas
- Surgery
Cite this
Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism. / Tsukahara, Kohei; Sato, Keiji; Yumoto, Tetsuya; Iida, Atsuyoshi; Nosaka, Nobuyuki; Terado, Michihisa; Naito, Hiromichi; Orita, Yorihisa; Naito, Tomoyuki; Miki, Kentaro; Sugihara, Mayu; Nagao, Satoko; Ugawa, Toyomu; Nakao, Atsunori.
In: International Journal of Surgery Case Reports, Vol. 26, 2016, p. 217-220.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism
AU - Tsukahara, Kohei
AU - Sato, Keiji
AU - Yumoto, Tetsuya
AU - Iida, Atsuyoshi
AU - Nosaka, Nobuyuki
AU - Terado, Michihisa
AU - Naito, Hiromichi
AU - Orita, Yorihisa
AU - Naito, Tomoyuki
AU - Miki, Kentaro
AU - Sugihara, Mayu
AU - Nagao, Satoko
AU - Ugawa, Toyomu
AU - Nakao, Atsunori
PY - 2016
Y1 - 2016
N2 - Introduction Massive bleeding from the thyroid gland causing airway compromise secondary to indirect neck trauma is rare. Presentation of case An 89-year-old woman was transferred to our emergency department due to anterior neck pain after a traffic accident. She had been propelled forward and struck her head on the front mirror during emergency braking. Airway patency was confirmed at the first contact. Although her vital signs were stable at presentation, she gradually suffered from respiratory distress and severe dyspnea, implying airway compression, therefore requiring endotracheal intubation. Computed tomography (CT) revealed a large, encapsulated hematoma in the left thyroid gland lobe extending to the upper mediastinum. Contrast-enhanced CT demonstrated an extravasation of the contrast agent around the left superior thyroid artery. The left thyroid artery was ligated and the hematoma was removed immediately. She had a favorable course without further complications and was discharged 36 days after admission. Discussion Airway management is the most important consideration in patients with thyroid injury. Treatment should be customized depending on the degree of respiratory distress resulting from of either involvement of the direct airway or secondary compression. Conclusion Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.
AB - Introduction Massive bleeding from the thyroid gland causing airway compromise secondary to indirect neck trauma is rare. Presentation of case An 89-year-old woman was transferred to our emergency department due to anterior neck pain after a traffic accident. She had been propelled forward and struck her head on the front mirror during emergency braking. Airway patency was confirmed at the first contact. Although her vital signs were stable at presentation, she gradually suffered from respiratory distress and severe dyspnea, implying airway compression, therefore requiring endotracheal intubation. Computed tomography (CT) revealed a large, encapsulated hematoma in the left thyroid gland lobe extending to the upper mediastinum. Contrast-enhanced CT demonstrated an extravasation of the contrast agent around the left superior thyroid artery. The left thyroid artery was ligated and the hematoma was removed immediately. She had a favorable course without further complications and was discharged 36 days after admission. Discussion Airway management is the most important consideration in patients with thyroid injury. Treatment should be customized depending on the degree of respiratory distress resulting from of either involvement of the direct airway or secondary compression. Conclusion Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.
KW - Airway distress
KW - Blunt trauma
KW - Soft tissue hematoma
KW - Thyroid artery
UR - http://www.scopus.com/inward/record.url?scp=84991676926&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84991676926&partnerID=8YFLogxK
U2 - 10.1016/j.ijscr.2016.08.002
DO - 10.1016/j.ijscr.2016.08.002
M3 - Article
AN - SCOPUS:84991676926
VL - 26
SP - 217
EP - 220
JO - International Journal of Surgery Case Reports
JF - International Journal of Surgery Case Reports
SN - 2210-2612
ER -