title: Thyroid hemorrhage causing airway obstruction after intravenous thrombolysis for acute ischemic stroke.
abstract: BACKGROUND
  There are several life-threatening complications associated with intravenous thrombolysis after acute ischemic stroke such as symptomatic intracerebral hemorrhage, orolingual angioedema, or less frequent, bleedings of the mucosa or ecchymosis. Aside from these known critical incidents, rare and unfamiliar complications may be even more challenging, as they are unexpected and may mimic events that appear more frequently. We report a rare and unusual acute complication of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) (0.9 mg/kg) administered for acute ischemic stroke.
  
  
  METHODS
  Medical records, radiologic imaging, and pathologic specimens were reviewed.
  
  
  RESULTS
  A 86-year-old woman developed acute respiratory failure 20 h after thrombolysis with suspected angioedema triggered by intravenous rt-PA. The inspiratory stridor and dyspnea were unresponsive to bronchodilators, corticosteroids, and inhaled adrenaline. After endotracheal intubation, laryngoscopy showed no significant supraglottic narrowing. Thyroidal sonography and cervical computed tomography revealed a thyroidal mass causing a tracheal and vascular compression compatible with thyroidal hemorrhage. Sonography showed a nodular goiter of the right thyroid gland. A total thyroidectomy was performed and histologic analysis confirmed a hemorrhage of the right thyroidal lobe.
  
  
  CONCLUSIONS
  Acute airway obstruction with respiratory failure due to thyroidal hemorrhage after intravenous thrombolysis is an important life-threatening complication, mimicking an anaphylactic reaction or a more frequent orolingual angioedema.
authors: Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors: Raoul
authors: R
authors: Sutter
authors: Elisabeth
authors: E
authors: Bruder
authors: Mandy
authors: M
authors: Weissenburg
authors: Gianmarco M
authors: GM
authors: Balestra
mesh_terms: D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D006044:Goiter, Nodular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006470:Hemorrhage / Q000139:chemically induced / Q000150:complications*; D006801:Humans; D011859:Radiography; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D010959:Tissue Plasminogen Activator
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