[Traumatic thyroid rupture: case report and review of the literature]

Traumatic hemorrhage of the thyroid as a work-related injury: a case report and review of the literature

Traumatic hemorrhage of the thyroid gland resulting from blunt injury to the neck is a very rare event. Particular neck positions can expose the thyroid to trauma, especially in motor vehicle collisions, falls, direct blows, or sport activities. Preexisting conditions such as goiters, adenomas, and cysts can increase the risk of bleeding, reducing the force required to rupture the gland and make the thyroid more prone to injury. The authors report the case of a 53-year-old man who was involved in a fire while working on maintenance of a liquid petroleum gas (LPG)-powered car. He subsequently presented to the emergency department with painful swelling of his right anterior neck with a palpable mass. CT scan showed a right thyroid hemorrhagic cyst. The worker reported that he had jumped into the car trunk to extinguish the fire and covered the gas tank nozzle with his own body to prevent dispersal of the accelerant. In this case, the medico-legal evaluation was useful to delineate between natural and traumatic causes of the injury. Medico-legal assessment is key in understanding the dynamics involved in work-related events to identify any legal responsibilities of the worker or the employer.

Isolated thyroid hematoma after blunt neck trauma presented with aphonia

Isolated thyroid rupture and hematoma are rare following blunt neck injury and can lead to airway compromise and the need for emergency management. We report a 23-year-old male patient who presented with neck swelling and aphonia following a road traffic accident. Contrast-enhanced CT scan showed laceration and hematoma involving left thyroid lobe. The patient underwent left hemithyroidectomy and accomplished complete recovery. A high index of suspicion for thyroid rupture must be maintained when patients presented with voice changes or respiratory distress.

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

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The proximity to the skin’s surface make several vital structures vulnerable to injury after blunt neck trauma.

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Isolated injury to the thyroid gland is rare and most cases have a predisposing disease such as goiter.

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CT-scan is helpful in evaluating the neck structures and evidencing injury to the thyroid.

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Surgical exploration remains the most common treatment strategy, all cases should be individualized.

Introduction

Soft tissue injuries are relatively common after blunt neck trauma, because of its complex anatomy, many vital structures can be compromised. Isolated trauma to the thyroid is highly uncommon and there are few cases reported in the literature.

Presentation of case

A 19 year-old female patient with no known pathologies who sustained direct blunt trauma to the right frontal half of the neck after falling down from a stair case. She arrived at the ER with moderate neck swelling and pain. There were no visible hematomas and no respiratory compromise was noted. Contrast enhanced CT-scan showed rupture and hematoma of the right thyroid lobe; she underwent surgical exploration with hemi thyroidectomy and recovered uneventfully.

Discussion

Despite soft tissue injuries are relatively common after blunt neck trauma, isolated thyroid gland injury is extremely rare and is present in about 1–2% of the cases and in most of the cases there is an underlining pathology within the gland. Most patients arrived at the emergency room hemodynamically stable, presenting neck swelling, pain, respiratory distress, dysphagia and hoarseness. Diagnosis strategy should be focused to rule out respiratory or vascular compromise. Surgical exploration remains the most common treatment strategy.

Conclusions

Although the rarity of this condition, physicians should take in mind the possibility of thyroid injury after blunt neck trauma. Early detection and prompt treatment, can reduce life threatening complications. Management should be individualized to patient’s characteristics and surgeon’s experience.