ACUTE AIRWAY OBSTRUCTION DUE TO CERVICAL GOITER IN A POST-OPERATIVE PATIENT

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Benign cervical goiter, though very common, is a rare cause of upper airway obstruction. In most cases there is a significant retrosternal extension of the goiter that leads to chronic respiratory failure. Here we present a case of upper airway obstruction due to a cervical goiter causing acute respiratory failure in a post-operative patient. CASE PRESENTATION: A 67-year-old woman with a past medical history of diabetes, hypertension, coronary artery disease and hypothyroidism presented to our facility with palpitations and shortness of breath. She underwent extensive evaluation including cardiac catheterization, which showed triple vessel disease. She was subsequently referred for coronary artery bypass grafting. On the second postoperative day, the patient developed sudden onset of shortness of breath and complained of feeling like her throat was closing. She was intubated for acute respiratory failure and placed on mechanical ventilation. Extubation was attempted twice in the post-operative period, but on both occasions, she relapsed into hypercarbic respiratory failure shortly after withdrawal of the endotracheal tube. After a prolonged period of intubation, she was referred for tracheostomy. She eventually required a subtotal thyroid resection before the trachea could be accessed. She was discharged with the tracheostomy in place DISCUSSION: Our patient had multiple comorbid conditions, underwent a major surgical procedure and received analgesic medications with sedative properties. These elements taxed her physiological reserve. She was therefore unable to maintain the same respiratory effort and could no longer overcome the resistance caused by airway narrowing due to the goiter. After prolonged intubation and failed attempts at extubation, tracheostomy was felt necessary. Benign goiters are very common, but do not often lead to upper airway obstruction. However, in critically ill or in post-operative patients, they can have significant influence on the prognosis. The presence of a large cervical goiter should be viewed as a risk factor for upper airway obstruction during the post-operative period. CONCLUSIONS: Acute respiratory failure due to benign cervical goiter is uncommon. However, in post-operative or critically ill patients, it should be factored as a potential cause of respiratory failure and considered during the pre-operative assessment. Reference #1: Bayhan Z, Zeren S, Ucar BI, et al. Emergency thyroidectomy: Due to acute respiratory failure. Int J Surg Case Rep. 2014;5(12):1251-3. Reference #2: White ML, Doherty GM, Gauger PG. Evidence-based surgical management of substernal goiter. World J Surg. 2008;32(7):1285-300. Reference #3: Ito T, Shingu K, Maeda C, et al. Acute airway obstruction due to benign asymptomatic nodular goiter in the cervical region: A case report. Oncol Lett. 2015;10(3):1453-1455. DISCLOSURES: No relevant relationships by Israel Acosta Sanchez, source=Web Response no disclosure on file for Ali Ashraf; No relevant relationships by Anthony Chahin, source=Web Response No relevant relationships by Jovan Gayle, source=Web Response No relevant relationships by Relin Yang, source=Web Response