Patient with neck swelling.

Abstract

An approximately 70-year-old female with a history of anaplastic thyroid cancer with metastasis to the lungs and cervical spine presented to the emergency department with a new fluctuant neck swelling of approximately 1 week's duration (Figure 1, Video 1). The mass was non-tender but oscillated paradoxically with respirations. The patient also noted a mildly hoarse voice. One month previously, she underwent total radical thyroidectomy with extensive soft tissue resection, including cricotracheal resection with primary re-anastomosis. The patient underwent computed tomography with contrast of the neck. (Figure 2). The computed tomography revealed a large, predominantly air-filled collection in the anterior neck measuring 7 × 6 × 6 cm and communicating with a contained tracheal perforation. The patient was taken to the operating room the following day, confirming breakdown of the cricotracheal repair. The patient underwent debridement and revision tracheostomy. Tracheal dehiscence is the complete disruption of the tracheal wall. This is in contrast to tracheal diverticulum, which represents an outpouching of the tracheal wall.1, 2 Anastomotic dehiscence occurs in 2.5%–11% of postoperative patients.3, 4 Known risk factors for dehiscence include diabetes and laryngotracheal resections, as well as long resections, pediatric age group, preoperative tracheostomy, and tension on the anastomosis. The current case is unusual in the timing of the diagnosis (1 month after surgery) and the large size of the perforation.5, 6 Surgical complications of tracheal repair may occur in up to 27% of patients. Bilateral recurrent nerve palsy is the most common complication. Other potential complications include anastomotic dehiscence, hypoparathyroidism, glottic edema, anastomotic stenosis, bleeding, respiratory insufficiency, and ventilator dependency.7, 8