Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism
| Autor: | Hiromichi Naito, Satoko Nagao, Michihisa Terado, Keiji Sato, Atsunori Nakao, Yorihisa Orita, Kentaro Miki, Atsuyoshi Iida, Toyomu Ugawa, Kohei Tsukahara, Mayu Sugihara, Tomoyuki Naito, Tetsuya Yumoto, Nobuyuki Nosaka |
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| Rok vydání: | 2016 |
| Předmět: |
endocrine system
medicine.medical_specialty endocrine system diseases Case Report 03 medical and health sciences 0302 clinical medicine Hematoma Massive bleeding medicine 030223 otorhinolaryngology Neck trauma Airway distress business.industry Thyroid Artery Thyroid Soft tissue 030208 emergency & critical care medicine respiratory system medicine.disease Soft tissue hematoma Surgery Airway Compromise medicine.anatomical_structure Blunt trauma Radiology business Thyroid artery |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2016.08.002 |
| Popis: | Highlights • Massive bleeding from the thyroid without direct neck trauma rarely causes airway compromise. • 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. • Airway management is the most important consideration in such patients with thyroid injury. 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. |
| Databáze: | OpenAIRE |
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