Acute goiter hematoma following blunt neck trauma

doi:10.1016/S0196-0644(87)80247-0

Annals of Emergency Medicine

Volume 16, Issue 11, November 1987, Pages 1300-1301

https://doi.org/10.1016/S0196-0644(87)80247-0 Get rights and content

Traumatic hemorrhage into the thyroid gland is rarely reported. We report the case of a 30-year-old man who sustained blunt trauma to his neck, resulting in hemorrhage into a previously existing goiter. The patient's goiter was drained in the hospital. He was doing well at a three-month follow-up.

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Cited by (32)

Thyroid Trauma—A National Analysis of Incidence, Mortality, and Concomitant Injury
2019, Journal of Surgical Research
Traumatic injury to the thyroid is rare with no large national studies in the literature. We sought to describe the incidence of traumatic thyroid injury and to compare injury characteristics, operative interventions, and outcomes of isolated thyroid versus thyroid and concomitant neck injury.
The National Trauma Data Bank (2007-2015) was used to identify patients with thyroid injury. Concomitant injury to surrounding neck structures included the trachea, esophagus, carotid arteries, cervical spine vertebrae, or vertebral arteries. A multivariable logistic regression analysis was performed.
The incidence of thyroid injury was <0.1%. Of these, 59.7% of patients had isolated thyroid injury and 40.3% had thyroid and concomitant neck injury. Most patients in both groups had a penetrating mechanism (75.8% and 85.6%). Thyroid operative intervention was rare in both groups (isolated thyroid injury 19.3%, thyroid and concomitant neck injury 22.1%). Direct thyroid repair was the most common type of surgical intervention performed (isolated thyroid 13.1% versus thyroid and concomitant neck injury 15.1%; P = 0.280), whereas total thyroidectomy was only performed in a single patient. Mortality was decreased for patients with isolated thyroid injury compared with thyroid and concomitant neck injury (8.9% versus 19%; P < 0.001).
Thyroid injury in trauma patients is extremely rare and occurs more frequently with penetrating trauma. Isolated thyroid trauma is associated with a lower risk of mortality, compared to thyroid trauma with concomitant neck injury. Most thyroid injury is treated nonoperatively, and when operative intervention is required, direct thyroid repair is most commonly performed.
Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism
2016, International Journal of Surgery Case Reports
Citation Excerpt :
Since adenomatous thyroid glands are more fragile, contain increased vascular flow, and lack a true capsular covering, their greater propensity for injury is easily explained. Spontaneous hemorrhage of a pre-existing thyroid cyst or nodule has also been recognized [2–4]. Our patient’s anterior neck skin did not show any abnormal signs from the secured seat belt, presumably because she had no direct contact with the front deck of the car.
Massive bleeding from the thyroid gland causing airway compromise secondary to indirect neck trauma is rare.
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 36 days after admission.
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.
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.
Thyroid gland rupture: A rare finding after a blunt neck trauma
2013, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
Most of the morbidities are associated with penetrating traumas. Never the less, blunt traumas come with their own list of injuries, usually they are airway or major neurovascular in nature [1]. Thyroid gland rupture from a blunt trauma is a very rare condition [2].
This is a case report of a 13 years old boy with a thyroid rupture secondary to a hockey stick blunt trauma to his neck and a literature review focused on diagnosis and management.
There are 14 other cases in the literature, 7 of which required surgical intervention mainly to evacuate a hematoma. The case in this review did not develop any complications.
This is the first reported case in the literature of thyroid gland rupture due to a blunt trauma in a child. Patients with thyroid gland rupture should be monitored closely for developing a hematoma or thyroid storm.
Thyroid rupture secondary to blunt neck trauma
2013, American Journal of Emergency Medicine
Thyroid gland rupture: A rare case of respiratory distress
2012, Journal of Emergency Medicine
Citation Excerpt :
Although blunt neck trauma is relatively rare, it can result in life-threatening injuries that demand immediate attention. Most case reports of thyroid rupture describe respiratory compromise, a palpable cervical mass, and pre-existing goiter disease (1,4). At initial presentation, the main concern is the integrity of the airway.
Background: Rupture of a normal thyroid gland after blunt cervical trauma is a rare case of airway compression. This case report describes the case of a 79-year-old woman who developed severe respiratory distress after a bicycle crash. Case Report: Presenting about 2 h after the crash, the patient noted cervical swelling and increasing dyspnea. The diagnosis of thyroid gland rupture was made with a combination of computed tomography scan, cervical radiography, and bronchoscopy. Invasive airway management was required in the first few hours after the crash. The patient underwent a left hemithyroidectomy, and recovered without complications. Conclusion: This case report highlights the fact that thyroid gland rupture can be a threatening complication of blunt cervical trauma.
Blunt Thyroid Trauma With Acute Hemorrhage and Respiratory Distress
2007, Journal of Emergency Medicine
Citation Excerpt :
Hemorrhage into the thyroid gland has been well recognized, but severe hemorrhage resulting in respiratory distress secondary to trauma is very rare. In previously reported cases, hemorrhage into the thyroid was caused by trauma, cervical hyperflexion, a manual blow to the back of the head, lifting a heavy weight, straining at defecation, and even during household work (1–6). In these cases, no emergent tracheal intubation was required.
We report a rare event of acute hemorrhage into a thyroid adenoma after blunt trauma and causing respiratory distress. A 65-year-old woman fell and hit the left side of her anterior neck without any other injuries. The next day, she suffered from severe dyspnea and respiratory distress, and visited a community hospital. She required endotracheal intubation and was immediately transferred to a regional emergency center. Computed tomography and magnetic resonance imaging revealed significant tracheal deviation to the right due to an extensive hematoma surrounded by a capsule in the left lobe of the thyroid gland with extension to the upper mediastinum. The patient was referred to our hospital because the diagnosis of malignant thyroid tumor was not completely ruled out. She successfully underwent left lobectomy of the thyroid gland without sternotomy. The pathological examination revealed follicular adenoma of the thyroid gland with massive intratumor bleeding.

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Case reportAcute goiter hematoma following blunt neck trauma

Am J Surg

Acute hemorrhage into the thyroid gland following trauma and causing respiratory distress

Br J Surg

Case report
Acute goiter hematoma following blunt neck trauma