Case report: presentation of delayed tracheal perforation after hemithyroidectomy

Hemithyroidectomy is a low-risk, outpatient procedure commonly performed for benign and some small, differentiated thyroid malignancies. Delayed tracheal perforation following thyroid surgery is exceedingly rare and has previously only been reported after total thyroidectomy. We describe a 25-year-old patient who underwent an unremarkable right hemithyroidectomy to remove a 4-centimeter fine needle aspiration cytologically indeterminate thyroid nodule, and presented 4 weeks later with acute anterior neck swelling and subcutaneous emphysema after strenuous exercise. Computed tomography showed pockets of air tracking along a right lateral tracheal wall irregularity on the operative side. Flexible tracheobronchoscopy identified a corresponding pinhole-sized defect. A bedside neck exploration was performed with drain placement. The patient was restricted to limited activity for 4 weeks, and recovered uneventfully. Surgeons who perform thyroid surgery must be aware of the possibility of delayed tracheal perforation after hemithyroidectomy. Conservative management may be appropriate for the stable patient.