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Thyroid gland hemorrhage after blunt neck trauma: case report and review of the literature

机译:钝性颈部外伤后甲状腺出血:病例报告及文献复习

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Thyroid hemorrhage is considered to be an uncommon complication following blunt trauma to the neck. This condition is potentially life-threatening due to airway compression and may therefore require emergency airway management and surgical intervention in some cases. We present the case of a 52-year-old woman who experienced a traumatic thyroid gland rupture (right lobe) with subsequent active arterial bleeding from branches of the inferior thyroid artery. On the same day, the patient presented to our emergency department with a painful swelling of the neck with an inspiratory stridor and hoarseness a few hours after a cycling accident. A right hemithyroidectomy was performed. The postoperative course was uneventful. We identified 33 additional cases published in English literature within the last 30?years, reporting blunt trauma to the neck with hemorrhagic complication of the thyroid gland. We provide a systematic review and particularly consider the aspects of endocrine surgery. The treatment approach for patients with blunt thyroid trauma should be dependent on the extent of the thyroid injury. Patients with tracheal compression, active bleeding and increasing hoarseness/shortness of breath require emergency airway control and often surgical exploration for hemorrhage control followed by resection of the ruptured thyroid. Importantly, in contrast to routine thyroid surgery, no electromyographic endotracheal tube is used during emergency intubation. Exchange of an endotracheal tube should be carefully evaluated due to difficult airway management in this setting. For protection against double-sided recurrent nerve palsy and postoperative hypoparathyroidism, a unilateral approach is preferable whenever possible.
机译:甲状腺出血被认为是对颈部钝性损伤的罕见并发症。由于气道受压,这种情况可能危及生命,因此在某些情况下可能需要紧急气道管理和手术干预。我们提供了一个52岁的女性的案例,该女性经历了甲状腺外伤性破裂(右叶),随后从甲状腺下动脉分支活动性大出血。当天,在骑车事故发生几小时后,患者就诊到我们的急诊科,颈部疼痛肿胀,吸气喘鸣,声音嘶哑。右半甲状腺切除术。术后过程很顺利。在过去的30年中,我们发现了33例在英国文献中发表的其他病例,这些病例报告了颈部钝性损伤并伴有出血性甲状腺并发症。我们提供系统的审查,尤其是考虑内分泌手术的各个方面。甲状腺钝性损伤患者的治疗方法应取决于甲状腺损伤的程度。气管受压,活动性出血和声音嘶哑/呼吸急促增加的患者需要紧急气道控制,并经常进行外科手术探索以控制出血,然后切除破裂的甲状腺。重要的是,与常规的甲状腺手术相比,在急诊插管时不使用肌电图气管插管。由于这种情况下的气道管理困难,应仔细评估气管插管的更换。为了防止双面复发性神经麻痹和术后甲状旁腺功能低下,只要可能,最好采用单侧入路。

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