title: [Severe dyspnea by combination of cervical spondylosis and struma].
abstract: CASE HISTORY PHYSICAL EXAMINATION: A 79-years-old female suffered from cervical pain for several years which radiated in both shoulders. A nodular goiter was already known and therefore a radio iodine treatment had been planned. Eight months ago the patient noticed a progressing breathlessness. Emergency admission happened due to inspiratory stridor and severe attacks of dyspnoea. Sufficient breathing was only possible by wearing a rigid cervical collar. There were no neurological deficits.
  
  
  RESULTS
  Tracheoscopy showed a mass in the dorsal cervical region. The cervical x-ray, computed tomography and magnet resonance imaging conformed a distinct spondylopathy at the leading edge of the cervical vertebral bodies including ventralisation of the oesophagus and narrowing of the trachea (>50%).
  
  
  RESULTS
  Simultaneously a total thyroidectomy, including neuromonitoring of the N. vagus, and ventral microsurgical resection of the spondylopathy was performed. There was no relapse of dyspnoea in the following year.
  
  
  CONCLUSIONS
  The coincidence of a goiter and ventral cervical spondylopathy accompanied by significant dyspnoea is remarkable. The order of diagnostic steps in this emergency case displays a major problem. The patient was scheduled for goiter surgery and admitted as emergency due to a stridor. The cervical spondylopathy was diagnosed by tracheoscopy and cervical x-ray. This case report emphasizes the importance to think about cervical lesions in the presence of a goiter and dyspnoea. To find out quickly whether there is a cervical lesion or not a x-ray should be obtained. Missing these lesions can result in a fatal course.
authors.affiliation: Klinik für Neurochirurgie, Klinikum Landshut.
authors.forename: Dieter
authors.initials: D
authors.lastname: Woischneck
authors.affiliation: Klinik für Allgemein-, Viszeral- u. Thoraxchirurgie, Klinikum Landshut.
authors.forename: Anna
authors.initials: A
authors.lastname: Eder
authors.affiliation: Medizinische Klinik I - Innere Medizin, Klinikum Landshut.
authors.forename: Axel
authors.initials: A
authors.lastname: Holstege
authors.affiliation: Klinik für Neurochirurgie, Universitätsklinikum Ulm.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kapapa
authors.affiliation: Klinik für Nuklearmedizin, Klinikum Landshut.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Scher
authors.affiliation: Klinik für Neurochirurgie, Klinikum Landshut.
authors.forename: Michael
authors.initials: M
authors.lastname: Schütze
authors.affiliation: Abteilung für Radiologie, Paracelsus-Klinik Osnabrück.
authors.forename: Norbert
authors.initials: N
authors.lastname: Blumstein
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology*; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006042:Goiter / Q000150:complications; D006801:Humans; D011859:Radiography; D012135:Respiratory Sounds / Q000209:etiology; D055009:Spondylosis / Q000150:complications* / Q000175:diagnosis*; D014135:Tracheal Stenosis / Q000150:complications* / Q000175:diagnosis*