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Case report: presentation of delayed tracheal perforation after hemithyroidectomy
Melina J Windon1, Vaninder Dhillon1, Ralph P Tufano1
1Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
AME Case Reports
|September 29, 2018
Summary
Delayed tracheal perforation is a rare complication following hemithyroidectomy, even after outpatient procedures. This case highlights the importance of recognizing this risk in thyroid surgery patients.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Thoracic Surgery
Background:
- Hemithyroidectomy is a common, low-risk outpatient procedure for benign thyroid nodules and small differentiated thyroid cancers.
- Delayed tracheal perforation is an exceedingly rare complication of thyroid surgery, with prior reports exclusively after total thyroidectomy.
Observation:
- A 25-year-old patient developed acute anterior neck swelling and subcutaneous emphysema four weeks post-hemithyroidectomy after strenuous exercise.
- Imaging revealed air tracking along the tracheal wall, and bronchoscopy confirmed a pinhole-sized tracheal defect on the operative side.
Findings:
- A bedside neck exploration with drain placement was performed for the tracheal perforation.
- The patient recovered uneventfully after four weeks of restricted activity, indicating conservative management can be effective.
Implications:
- Surgeons performing thyroid surgery must consider the potential for delayed tracheal perforation, even after hemithyroidectomy.
- This case expands the understanding of tracheal injury following thyroidectomy and suggests conservative management is a viable option for stable patients.
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