title: Late manifestation of tracheal rupture after thyroidectomy: case report and literature review.
abstract: OBJECTIVE
  To report an extremely rare case of delayed tracheal rupture after thyroidectomy and to review the existing related literature.
  
  
  METHODS
  We present the history, clinical findings, radiographic evaluation, management, and intraoperative findings in a patient who presented with subcutaneous emphysema 9 days after total thyroidectomy. In addition, we review the literature and discuss the diagnostic challenges as well as management options.
  
  
  RESULTS
  A 17-year-old female patient underwent a total thyroidectomy for Graves disease. On postoperative day 9, the patient presented with face and neck swelling attributable to subcutaneous emphysema. After conservative management failed, the patient underwent surgical exploration of the neck, which revealed a 2.5-cm linear vertical tear in the anterior aspect of the trachea, with no evidence of necrosis. The tear had viable edges and was primarily repaired with use of muscle flap reinforcement. The patient recovered with no other complications.
  
  
  CONCLUSIONS
  Delayed tracheal rupture should be suspected in all patients who present with subcutaneous emphysema after a thyroid surgical procedure. Review of the pertinent literature suggests that conservative management is suitable in patients with a stable condition. Surgical repair is indicated in those patients who fail to demonstrate clinical improvement.
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA.
authors.forename: Hagig
authors.initials: H
authors.lastname: Mazeh
authors.forename: Pasithorn A
authors.initials: PA
authors.lastname: Suwanabol
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D004564:Electrocoagulation / Q000009:adverse effects; D005260:Female; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D012422:Rupture, Spontaneous / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D013352:Subcutaneous Emphysema / Q000209:etiology; D013524:Surgical Flaps; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors; D014133:Tracheal Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000009:adverse effects