Janine Beatrice Borja, BSN, MD
Internal Medicine Resident Physician
Mercyhealth
Huntley, Illinois, United States
Disclosure information not submitted.
Lintu Ramachandran, MD
Internal Medicine Resident Physician
Mercyhealth, United States
Disclosure information not submitted.
Taha Mohamed Djirdeh, MD
Internal Medicine Resident Physician
Mercyhealth, United States
Disclosure information not submitted.
Zaher Qassem, MD, FCCP
Attending Physician, Pulmonary and Critical Care
Mercyhealth, United States
Disclosure information not submitted.
Nicole Gentile, MD
Research Director
Mercyhealth, United States
Disclosure information not submitted.
Luqman Baloch, MD
Assistant Research Director
Mercyhealth, United States
Disclosure information not submitted.
Title: Cervical Hemorrhage Due to Non-traumatic Superior Thyroid Artery Rupture
Case Report Body:
Introduction: Spontaneous rupture of the thyroid arteries is a rare phenomenon. It has been previously reported with thyroid artery aneurysm, parathyroid adenoma, and multinodular goiter. Here, we describe a case of non-traumatic rupture of the superior thyroid artery complicated by respiratory failure and acute blood loss anemia.
Description: An 83-year-old female with history of hypertension, CKD, aortic stenosis, and C3-C7 spinal fusion presented to the ED with sudden-onset of neck swelling and bruising on the left side of the neck, dysphagia and dyspnea. She denied having fever, chills, headache, neck stiffness, vision changes, chest pain, cough, focal weakness, trauma, history of head/neck tumor, or recent neck trauma or manipulation. Labs were remarkable for hemoglobin 10.8 g/dL, WBC 8.6, platelet 254, BUN 41, Cr 1.2, and INR 1. Further evaluation with neck CT showed a 3.9 x 3.5-cm hyperdense focus with rightward displacement of the trachea and concern for contrast extravasation. Multiphase chest CT redemonstrated probable bleeding from thyroid branch of the external carotid artery with ongoing extravasation in the neck only. Evaluation of the posterior mediastinum was limited by a large hiatal hernia. Oral contrast was not possible due to dysphagia. Hemoglobin dropped to 6.9 from 10.8 g/dL for which she was transfused 1 unit pRBC. She subsequently underwent emergent neck angiography with endovascular embolization of the left superior thyroid arteries. Patient remained intubated post-procedure and had difficulty being weaned off the ventilator, ultimately requiring tracheostomy and percutaneous endoscopic gastrostomy tube placement. Patient was discharged to a long-term acute care facility.
Discussion: Rupture of the superior thyroid artery is extremely uncommon and necessitates early identification and management due to associated increased morbidity and mortality. It was first reported in 2009, and the incidence is unknown given its rarity. Diagnosis is challenging as symptom presentation is broad, including dyspnea, hoarse voice, dysphagia and neck swelling. Prompt recognition with CT angiography of the neck is important. Optimal management involves airway management, prompt diagnosis, and endovascular intervention.