title: A case of airway obstruction secondary to acute haemorrhage into a benign thyroid cyst.
abstract: A 70-year-old female, with a history of progressive dyspnoea, was admitted to the critical care unit after successful resuscitation following a witnessed, out of hospital cardiorespiratory arrest. A presumptive diagnosis of cardiorespiratory arrest secondary to an exacerbation of chronic obstructive pulmonary disease was made. However, on more detailed examination a large anterior, midline neck mass was noted. Following tracheal intubation, a computerised tomography scan of the patient's neck and thorax revealed a seven-centimetre, well-defined, nonenhancing, rounded homogeneous opacity at the thoracic inlet, consistent with a large midline thyroid cyst. Needle aspiration of the cyst was performed and yielded approximately 50 mL of frank blood. After an uncomplicated tracheal extubation and recovery, an elective subtotal thyroidectomy was performed prior to hospital discharge. Histology of the specimen revealed a benign thyroid cyst within a multinodular goitre. Euthyroid multinodular goitres are more likely to be managed conservatively due to an asymptomatic clinical course in most patients. However, the risk of respiratory distress and acute airway obstruction from tracheal compression or acute haemorrhage should be kept in mind. Patients at risk of this life threatening complication should be managed with elective thyroidectomy to reduce morbidity and mortality.
authors.affiliation: Sandwell & West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
authors.forename: Ravi
authors.identifier: 0000-0002-2472-5538
authors.initials: R
authors.lastname: Vijapurapu
authors.affiliation: Sandwell & West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
authors.forename: Kamal
authors.initials: K
authors.lastname: Kaur
authors.affiliation: Academic Department of Anaesthesia, Critical Care, Pain & Resuscitation, Birmingham Heartlands Hospital, 1st Floor MIDRU Building, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Crooks