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July 1991, Volume 41, Issue 7

Case Reports

SPONTANEOUS HAEMORRHAGE IN GOITRE CAUSING RESPIRATORY DISTRESS

Asif Zafar  ( Departments of Surgery, Rawalpindi Medical College, Rawalpindi. )
Khalid Cheema  ( Departments of Surgery, Rawalpindi Medical College, Rawalpindi. )
Shehzad Latif  ( Department of Surgery, District Headquarter Hospital, Rawalpindi. )

Haemorrhage in goitre is well known complication. Rarely it can produce respiratory distress. A case which required emergency partial thyroidectomy is reported.

CASE REPORT

A 19 year old girl reported to the casualty department of our hospital, with dyspnoea and sudden increase in size of as welling in front of the neck, which was painful. She had had goitre for the last 2 years. Physical examination revealed an anxious girl sit­ting up in bed with obvious difficulty in breathing. Her vital signs were normal. The skin over her neck was oedematous with tense swelling on the left side. Cervical spine x-rays (Figure. 1)

showed soft tissue swelling on the left side of the neck with a marked shift of trachea to the right. Thyroid function tests and scan were not available the skin and subcutaneous tissues. The left lobe and isthmus of the thyroid gland were tense and haemor­rhagic (Figure 2).

The degenerated thyroid tissue present mainly in the left lobe was excised. The right lobe was normal. Her post-operative course was uneventful ex­cept for minor wound sepsis. The histology was reported as adenomatous colloid goitre with multiple areas of haemorrhage and necrosis.

DISCUSSION

Haeinorrhage in the thyroid gland usually occurs in pre-existing abnormalities. This has followed trauma,1,2 lifting heavy weight, 3 straining4 and even during household work, 5 as indeed in our case. This case illustrates the potential dangers of haemorrhage in goitre, and the need for urgent surgical intervention to prevent fatal extrinsic compression of the airway.

REFERENCES

1. Behrends, R.L. and Low, R.S. Acute goiter hemaroma following blunt neck trauma. Ann. Emerg. Med., 1987; 16: 1300.
2. Grace, R.H. and Shilling, J.S. Acute hemorrhage into the thyroid gland following trauma and causing respiratory distress. Br. 3. Surg., 1969; 56:635.
3. Ryan, W.J. Hemorrhage into the thyroid gland resulting from muscular effort: Report of a case. Ann. Surg., 1942; 115:469.
4. Wendel, A. Fetal adenoma with hemorrhage; operative procedure for relief of asphyxia with case report. Am.J. Surg., 1936; 31: 372.
5. Clute, H.M. Hemorrhage into thyroid adenoma. Surg. Clin. North Am., 1931; 11:445.

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