From neck swelling to abrupt compromised airway: A case of a hemorrhagic ruptured thyroid cyst

• Published in: Saudi journal of medicine & medical sciences Vol. 4; no. 3; pp. 229 - 232
• Main Authors: Al-Khalifa, Muneera, Sharif, Hiba, AlShehabi, Mohamed
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer - Medknow Publications 01.09.2016; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Airway compromise; Care and treatment; Case Report; Case studies; Complications and side effects; hemorrhagic rupture; Thyroid cancer; thyroid cyst; hemorrhagic rupture; thyroid cyst; Airway compromise
• ISSN: 1658-631X; 2321-4856
• DOI: 10.4103/1658-631X.188250

Here, we present a rare case of spontaneous hemorrhagic rupture of a benign thyroid cyst in an adult Indian female who had no history of thyroid gland disease, trauma or coagulopathies. The patient presented to the Emergency Department with a suddenly progressive left-sided neck swelling of short duration. A 36-year-old otherwise healthy female presented to our Emergency Department with a progressive swelling on the left side of her neck that had started 2 days before her visit. Initially, the clinical neck examination revealed a well-defined soft cystic lesion confined to the left side of the neck anteriorly, measuring around 4 cm × 4 cm, tender to touch and moving with deglutition. Preliminary flexible scope examination of her larynx was normal. Within a few hours of having undergone ultrasonography examination, the neck swelling became diffused with increased tenderness. However, the patient remained clinically stable with no signs of airway compromise. A repeat of the fiber optic flexible scope examination showed submucosal hematoma in the left aryepiglottic area that mildly pushed the patient's laryngeal inlet to the contralateral side. Shortly after, the patient's condition worsened with the progression of swelling leading to compression of the airway. This promoted the decision to intubate the patient, who was subsequently, managed conservatively with close monitoring in the intensive care unit. Postintubation ultrasonography and computer tomography scans showed diffused inflammatory changes on the left side of the neck in the superficial and deep planes, mainly confined to the infrathyroid. Spontaneous sudden hemorrhagic rupture of a thyroid gland cyst is a rare condition but should be considered in a massive abrupt neck swelling that could potentially be life threatening.