A Case of Cervical Hematoma after Blunt Thyroid Trauma

Abstract

Cervical hematoma after blunt thyroid trauma is rare, but may induce severe respiratory distress. We report a 69-year-old woman with cerebral infarction being treated with acetylsalicylic acid, who was transferred to our hospital by helicopter ambulance (HEMS : Helicopter Emergency Medical Service) with dyspnea and cervical swelling after a fall. Endoscopic examination revealed laryngeal edema, and X-ray revealed severe stenosis of the trachea. Because of the severe laryngeal edema, she could not be intubated. Suddenly, her oxygen saturation decreased, and because standard ventilation was not possible, we elected to perform a tracheostomy. On incision of the skin, we found a massive outflow of retained blood from her neck, whereupon her oxygen saturation was instantly improved. Ultimately, nasal intubation was performed using a flexible endoscope, without resorting to a tracheostomy. Computed tomography of the neck revealed a crushed thyroid gland. She gradually recovered without complications. Cervical hematoma sometimes results in severe respiratory distress, and the decision of whether to intubate or perform a tracheostomy should be taken cautiously.