Isolated thyroid hematoma after blunt neck trauma presented with aphonia

Alnjadat, Ismail; Obeidat, Moh'd; EL-Sukkar, Wisam; AL-Swalgh, Mahmoud

doi:10.1016/j.mjafi.2019.02.001

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…3 Our patient suffered from direct, blunt trauma to the neck, but other similar injuries noted were penetrating neck injuries, vehicular accidents, assaults, sports-related injuries, and fine-needle aspiration. [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Occurring less commonly are those arising from indirect mechanisms such as straining from heavy physical activities, Valsalva from coughing or defecating, and deceleration injuries. 1,3,4 There have also been rare instances of spontaneous thyroid bleeding, but most were associated with preexisting thyroid pathology and chronic anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Rupture Secondary to Blunt Neck Trauma: A Case Report

Perdon-Chan¹,

Roasa²

2022

Craniomaxillofacial Research & Innovation

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Aim To discuss the clinical presentation of thyroid rupture following blunt neck trauma and highlight key management principles for the case. Methods A 45-year-old female motorcycle passenger with a pre-existing right thyroid nodule hit her right anterior neck against a bottle during sudden stop and developed painful right neck swelling, odynophagia, and hoarseness. She was seen at the emergency room 5 hours post-injury, awake, cooperative, and ambulatory, without stridor or dyspnea at room air. On examination, she had ecchymoses behind her right tonsillar pillars; her neck was grossly swollen and was tender on palpation without subcutaneous emphysema. Laryngoscopy showed good left vocal cord mobility while the right vocal cord had a visible hemorrhage and limited abduction due to the mass effect of the hematoma seen at the right aryepiglottic area extending toward the right piriform fossa and the right parapharyngeal area. Intact bilateral vocal cord adduction was noted upon phonation. Contrast-enhanced computed tomography revealed hematoma formation in the right thyroid lobe area with extension to the right side of the oropharyngeal region, anterior cervical, parapharyngeal, and retropharyngeal space, confirming the aerodigestive tract narrowing and leftward deviation previously noted. Baseline thyroid function tests were normal. Under general anesthesia, the patient underwent neck exploration where the ruptured right thyroid lobe was resected, and the hematoma was evacuated. Results Postoperatively noted significant improvement in neck swelling, odynophagia, and hoarseness. Transient subclinical hyperthyroidism remained asymptomatic and resolved upon outpatient follow-up. A year after the surgery, the patient had a well-healed cervical scar, complete hematoma resolution, and regained her pre-morbid phonation. Conclusion Thyroid gland rupture should be among the considerations for patients presenting with tender neck swelling, progressive hoarseness, and/or dyspnea following neck trauma. Prompt airway assessment and close monitoring for potential compromise are essential to avoid fatal sequelae of external airway compression. Management varies from close observation to surgical neck exploration and should be personalized depending on the severity of thyroid injury and symptomatology.

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