Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism

Kohei Tsukahara, Keiji Sato, Tetsuya Yumoto, Atsuyoshi Iida, Nobuyuki Nosaka, Michihisa Terado, Hiromichi Naito, Yorihisa Orita, Tomoyuki Naito, Kentaro Miki, Mayu Sugihara, Satoko Nagao, Toyomu Ugawa, Atsunori Nakao

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 languageEnglish
Pages (from-to)217-220
Number of pages4
JournalInternational Journal of Surgery Case Reports
Volume26
DOIs
Publication statusPublished - 2016

Fingerprint

Hematoma
Rupture
Thyroid Gland
Neck
Wounds and Injuries
Emergencies
Arteries
Tomography
Hemorrhage
Airway Management
Intratracheal Intubation
Vital Signs
Neck Pain
Traffic Accidents
Mediastinum
Respiratory Insufficiency
Dyspnea
Contrast Media
Hospital Emergency Service
Head

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 journalArticle

Tsukahara, K, Sato, K, Yumoto, T, Iida, A, Nosaka, N, Terado, M, Naito, H, Orita, Y, Naito, T, Miki, K, Sugihara, M, Nagao, S, Ugawa, T & Nakao, A 2016, 'Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism', International Journal of Surgery Case Reports, vol. 26, pp. 217-220. https://doi.org/10.1016/j.ijscr.2016.08.002
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. / Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism. In: International Journal of Surgery Case Reports. 2016 ; Vol. 26. pp. 217-220.
@article{f0a3b8d7df9f46dc9afcdc4b010d1dc6,
title = "Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism",
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.",
keywords = "Airway distress, Blunt trauma, Soft tissue hematoma, Thyroid artery",
author = "Kohei Tsukahara and Keiji Sato and Tetsuya Yumoto and Atsuyoshi Iida and Nobuyuki Nosaka and Michihisa Terado and Hiromichi Naito and Yorihisa Orita and Tomoyuki Naito and Kentaro Miki and Mayu Sugihara and Satoko Nagao and Toyomu Ugawa and Atsunori Nakao",
year = "2016",
doi = "10.1016/j.ijscr.2016.08.002",
language = "English",
volume = "26",
pages = "217--220",
journal = "International Journal of Surgery Case Reports",
issn = "2210-2612",
publisher = "Elsevier BV",

}

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 -