Acute Airway Obstruction Due To Metastatic Renal Cell Carcinoma Cancer

摘要

This is the first reported case of an emergency total thyroidectomy following acute airway obstruction in secondary thyroid cancer. The patient had a previous nephrectomy for renal cell carcinoma some 21 years previously, and the thyroid histology revealed the presence of a clear cell renal metastasis. The presentation and the latent period from nephrectomy, make this case unique. The clinician must always be mindful of previous malignancy in cases of goitre-related airways obstruction. Case Report A 69 year old lady, with known thyroid goitre, presented acutely to the emergency department with cyanosis and near-total upper airway obstruction. Over the preceding one week she had been having increasing shortness of breath and over twenty fours hours had been unable to lie flat and had developed significant stridor. Her medical history included obstructive sleep apnoea for which she had noctural CPAP, euthyroid goitre and a previous renal cell carcinoma which was resected in 1985. Following her surgery, she received no adjuvant therapy.On clinical examination, she was grossly centrally cyanosed with a reduced conscious level. She was making some respiratory effort but there was minimal air entry. An initial blood gas revealed severe respiratory acidosis. A chest x-ray showed bilateral consolidation consistent with pulmonary oedema. Managing her airway proved particularly troublesome given that she could not lie flat to allow intubation and that there was no palpable cricothyroid membrane owing to her goitre. Her airway was therefore initially maintained with intermittent positive pressure ventilation via a bag and mask and she recovered sufficiently to allow transfer to the intensive care unit..Incidentally, her thyroid function tests were completely normal.A CT scan (see Fig 1.) revealed severe tracheal obstruction at the low cervical level from a massive goitre.