Multinodular Goiter Compressing the Trachea following Open Heart Surgery

Sajja, Lokeswara Rao; Mannam, Gopi Chand; Sompalli, Sriramulu; Simhadri, Chandra S R; Hasan, Ashfaq

doi:10.1177/021849230601400514

Cited by 13 publications

(16 citation statements)

References 4 publications

(3 reference statements)

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“…With respect to the risk factors for acute airway obstruction, studies have suggested that acute obstruction is due to sudden hemorrhage into a cyst, an upper respiratory tract infection causing edema, tracheal collapse or worsening of comorbidities (5,8,10,11). Since the patient in our case was asymptomatic, it was decided not to operate immediately.…”

Section: Discussionmentioning

confidence: 90%

Acute airway obstruction due to benign asymptomatic nodular goiter in the cervical region: A case report

et al. 2015

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Abstract. Benign nodular goiter is a common disease. Although large goiters with obstructive symptoms including shortness of breath and dyspnea are a clear indication for surgery, acute upper airway obstruction, particularly in benign cervical goiter cases, is rare. We herein report the case of 46-year-old female with acute upper airway obstruction due to benign nodular goiter. The patient had a large and elastic goiter which was more pronounced on the left side of her neck, and surgery was scheduled for within a few months. Three months after the initial presentation, while still waiting for surgery, the patient was brought to the emergency room due to loss of consciousness and breathing difficulty and was immediately intubated. A computed tomography (CT) scan revealed that the trachea was markedly compressed by a nodular lesion in the left lobe, and bilateral pneumonia was also evident. Total thyroidectomy was immediately performed via the supraclavicular approach. The patient had an uneventful postoperative course and recovered well. The resected specimen included a well-encapsulated solid and cystic mass. Histopathological examination mainly revealed adenomatous goiter. The present case suggests that benign asymptomatic nodular goiter mostly located in the neck may cause acute airway obstruction, even if the nodules are not large. Early surgery should be performed when tracheal deviation and stenosis due to a large goiter is prominent by CT scan.

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Section: Discussionmentioning

confidence: 90%

Acute airway obstruction due to benign asymptomatic nodular goiter in the cervical region: A case report

et al. 2015

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“…Sajja et al 9 reported a case of intrathyroidal haemorrhage causing respiratory failure shortly after cardiac valve replacement surgery in a 60-year-old woman.…”

Section: Discussionmentioning

confidence: 99%

Acute respiratory failure in a rapidly enlarging benign cervical goitre

2013

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Benign goitres have the potential to reach massive sizes if neglected, but most have a protracted course that may or may not present with compressive symptoms. We report the case of a 57-year-old man who presented with a rapidly enlarging nodular goitre resulting in acute respiratory failure. Endotracheal intubation and emergency total thyroidectomy were performed, revealing massive thyroid nodules with minimal intrathoracic extension and tracheal erosion. Despite a course and clinical findings suggestive of malignant disease, histopathology was consistent with a benign multinodular goitre. Several cases of benign goitres necessitating endotracheal intubation have been reported. Airway compromise was attributed to a significant intrathoracic component, or inciting events such as thyroid haemorrhage, pregnancy, radioiodine uptake or major surgery. Obstructive symptoms may not correlate well with objective measures of upper airway obstruction such as radiographs or flow volume loops.

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“…Acute airway obstruction due to rapidly enlarging goitre could occur following cardiac operation with cardiopulmonary bypass [17,18]. Cardiopulmonary bypass compromises the upper airway by initiating series of inflammatory responses which ultimately lead to systemic tissue oedema including acute enlargement of the thyroid gland [19,20].…”

Section: Should Thyroidectomy and Cabg Performed Concurrently?mentioning

confidence: 99%