title: Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism.
abstract: BACKGROUND
  Massive bleeding from the thyroid gland causing airway compromise secondary to indirect neck trauma is rare.
  
  
  METHODS
  An 89-year-old woman was transferred to our emergency department due to anterior neck pain after a traffic accident. She had been propelled forward and struck her head on the front mirror during emergency braking. Airway patency was confirmed at the first contact. Although her vital signs were stable at presentation, she gradually suffered from respiratory distress and severe dyspnea, implying airway compression, therefore requiring endotracheal intubation. Computed tomography (CT) revealed a large, encapsulated hematoma in the left thyroid gland lobe extending to the upper mediastinum. Contrast-enhanced CT demonstrated an extravasation of the contrast agent around the left superior thyroid artery. The left thyroid artery was ligated and the hematoma was removed immediately. She had a favorable course without further complications and was discharged 36days after admission.
  
  
  CONCLUSIONS
  Airway management is the most important consideration in patients with thyroid injury. Treatment should be customized depending on the degree of respiratory distress resulting from of either involvement of the direct airway or secondary compression.
  
  
  CONCLUSIONS
  Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Kohei
authors: K
authors: Tsukahara
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Keiji
authors: K
authors: Sato
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Tetsuya
authors: T
authors: Yumoto
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Atsuyoshi
authors: A
authors: Iida
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Nobuyuki
authors: N
authors: Nosaka
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Michihisa
authors: M
authors: Terado
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Hiromichi
authors: H
authors: Naito
authors: Department of Otorhinolaryngology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Yorihisa
authors: Y
authors: Orita
authors: Department of Otorhinolaryngology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Tomoyuki
authors: T
authors: Naito
authors: Department of Otorhinolaryngology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Kentaro
authors: K
authors: Miki
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Mayu
authors: M
authors: Sugihara
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Satoko
authors: S
authors: Nagao
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Toyomu
authors: T
authors: Ugawa
authors: Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan. Electronic address: qq-nakao@okayama-u.ac.jp.
authors: Atsunori
authors: A
authors: Nakao
keywords: Airway distress; Blunt trauma; Soft tissue hematoma; Thyroid artery