Abstract
BackgroundThere have been no reports of tracheal intubation for airway obstruction after acute thyroid swelling following fine-needle aspiration (FNA) of the thyroid gland.Case presentationA 58-year-old woman with a 22 mm × 13 mm right hypervascular thyroid nodule underwent FNA once with a 22G needle under ultrasonographic guidance. Shortly after the aspiration, ultrasound revealed hypoechoic swelling with a crack-like pattern. The patient was observed under bed rest in the Fowler position and received intravenous steroids. A computed tomography (CT) scan showed swelling not only of the thyroid but also of the retropharyngeal space, and the patient complained of difficulty swallowing saliva. Laryngeal fiberscopy revealed protrusion of the posterior pharyngeal wall, edematous changes in the mucosa of the pharynx and epiglottis, and retention of saliva. The patient was intubated awake and hydrocortisone was administered every 8 h. She was extubated 3 days after FNA and discharged without any complications.ConclusionsWhen neck swelling is noticed after FNA, ultrasonographic findings are especially important to assess potential causes. If airway obstruction is suspected, CT findings and fiberscope observation of the pharynx provide particularly useful information.
Highlights
There have been no reports of tracheal intubation for airway obstruction after acute thyroid swelling following fine-needle aspiration (FNA) of the thyroid gland.Case presentation: A 58-year-old woman with a 22 mm × 13 mm right hypervascular thyroid nodule underwent FNA once with a 22G needle under ultrasonographic guidance
When neck swelling is noticed after FNA, ultrasonographic findings are especially important to assess potential causes
The overall prevalence of acute, transient thyroid swelling was previously reported to be 0.46% [9], 0.15% [10], 0.13% [11], and 0.10% [6]. This swelling subsided within 1–20 h, and none of the patients developed airway obstruction. This is the first report in the English literature to describe a patient who required tracheal intubation for airway obstruction after acute thyroid swelling following FNA
Summary
When neck swelling is noticed after FNA, ultrasonographic findings are especially important to assess potential causes.
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