Cases reported "Goiter, Nodular"

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1/17. Bilateral recurrent nerve paralysis associated with multinodular substernal goiter: a case report.

    Substernal goiter is an infrequent occurrence and is found in two to five per cent of all patients undergoing thyroid surgery. These lesions are well known to cause respiratory symptoms and alterations in phonation due to direct compression of airway structures. Infrequently, unilateral recurrent nerve palsy has been reported in patients with substernal goiter. We report a case of bilateral recurrent nerve palsy associated with multinodular substernal goiter in an 89-year-old female who presented in respiratory distress.
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ranking = 1
keywords = airway
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2/17. Recurrent pregnancy-related upper airway obstruction caused by intratracheal ectopic thyroid tissue.

    An unusual case of recurrent pregnancy-related thyroid growth stimulation is reported. A 27-year-old euthyroid woman had pulmonary symptoms, thought to be asthma during her first pregnancy, that improved postpartum. Bronchodilatators had no effect and symptoms recurred from gestational week 22 during her second pregnancy. Her 58-mL multinodular goiter (by ultrasound) was not thought to be responsible for her upper airway symptoms. Therefore, fiber laryngoscopy and computed tomographic (CT) scan were performed and revealed a 20 x 15 x 10 mm intratracheal tumor. After tracheostomy and microlaryngoscopy, benign goitrous thyroid tissue was removed through a tracheal fissure during gestational week 35. Postoperatively the patient had stopped medication and was without any pulmonary symptoms. The child was delivered by cesarean section in gestational week 39. apgar score was normal and the child has developed normally. We believe that this case illustrates the recurrent effect of pregnancy-related thyroid tissue stimulation by a combination of increasing human chorionic gonadotropin (hCG) stimulation and iodine deficiency in a borderline iodine-deficient region. This is the first report on symptomatic intratracheal ectopic thyroid tissue diagnosed during pregnancy.
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ranking = 87.669831931926
keywords = airway obstruction, airway, obstruction
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3/17. Superior vena cava obstruction: a review of the literature and report of 2 cases due to benign intrathoracic tumors.

    A review of the literature shows an increaseing number of cases of superior vena cava obstruction associated with malignancy and a marked decrease in the number of patients with caval obstruction of benign origin. In contrast to granulomatous diseases and aneurysms of the ascending thoracic aorta, which have decreased, the incidence of benign tumors is essentially unchanged. Clinical features of superior vena cava obstruction in relation to the anatomical site of obstruction and collateral pathways are correlated. Diagnostic approaches, including angiography and technetium scanning are usually definitive in outlining the site of obstruction. Experimental data and the numerous available techniques for surgical correction indicate that an entirely satisfactory procedure is not available for all patients. methods include the use of venous bypass or Teflon prostheses and the addition of a small arteriovenous fistula proximally. Two new cases of superior caval obstruction due to benign tumor are reported. In 1 patient, who had intrapericardial bronchogenic cyst with fibrotic caval obstruction and thrombosis, a method for caval reconstruction while maintaining venous return to the right atrium is described. The second patient had an intrathoracic thyroid adenoma and caval obstruction without thrombosis.
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ranking = 7.5435683817924
keywords = obstruction
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4/17. Bilateral chylothorax due to retrosternal goiter in a patient with non-Hodgkin's lymphoma.

    Chylous pleural effusion, or chylothorax, usually results from obstruction to or disruption of the thoracic duct. Malignant etiologies are the most common cause of chylothorax, lymphoma accounting for the majority of non-traumatic chylous effusions. We report an unusual case of bilateral chylothorax associated with a retrosternal toxic multinodular goiter in a patient with non-Hodgkin's lymphoma. An ablative dose of 131I was administered with apparent initial clinical improvement. The pathogenesis of chylothorax and therapeutic considerations are discussed.
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ranking = 0.6286306984827
keywords = obstruction
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5/17. Elective awake intubation in a patient with massive multinodular goitre presenting for radioiodine treatment.

    We present the management of the potential airway complications in a case of massive multinodular goitre treated with radioactive iodine. The patient's trachea was prophylactically intubated, using a fibreoptic technique, to prevent further airway compromise due to thyroid oedema following radioactive iodine treatment. He remained awake and intubated for five days and was extubated when there was no clinical evidence of thyroid oedema as a consequence of his treatment. This approach avoided the considerable risk of thyroidectomy in a morbidly obese patient with airway obstruction. To the authors' knowledge this approach has not been previously described.
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ranking = 23.667457982982
keywords = airway obstruction, airway, obstruction
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6/17. life-threatening pulmonary oedema secondary to tracheal compression.

    We present a case of negative pressure pulmonary oedema due to an overlooked cause. A 45-year-old female patient presented to the emergency department unconscious with severe pulmonary oedema. Subsequent investigations revealed a thyroid goitre causing significant tracheal compression. This case report highlights an extremely rare but potentially dangerous sequela of upper airway obstruction.
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ranking = 21.667457982982
keywords = airway obstruction, airway, obstruction
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7/17. Cricoid pressure: beware the patient with a goitre.

    A case of acute thyroid swelling is reported following intubation of a young woman with a pre-existing small goitre. The thyroid enlargement then distorted the airway, necessitating an emergency thyroidectomy. The application of cricoid pressure was believed to have caused the intrathyroidal bleeding and the complications of cricoid pressure are reviewed.
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ranking = 1
keywords = airway
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8/17. life-threatening acute respiratory distress in late pregnancy.

    Acute severe ventilatory failure from any cause is always a critical emergency. In advanced pregnancy, such an episode is particularly hazardous. The management of a pregnant patient who presented with an acute episode of respiratory distress is described. Although this was though initially to be an asthmatic attack, there was evidence of upper airway obstruction caused by an enlarged thyroid. The major complicating factors and aetiology are discussed.
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ranking = 21.667457982982
keywords = airway obstruction, airway, obstruction
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9/17. Euthyroid goitre and sleep apnea.

    A number of predisposing factors (obesity, nasal obstruction, adenoidal hypertrophy, macroglossia, etc) have been related to obstructive sleep apnea syndrome (OSAS). In addition hypothyroidism and large goitres have been reported to be associated to OSAS, but this association has not been adequately studied. We describe an obese patient with euthyroid goitre associated with OSAS. The patient showed a body mass index (BMI) of 47 and a large neck with a circumference of 60 cm. The flow-volume curve demonstrated an expiratory plateau suggesting an intrathoracic upper airway obstruction. Arterial blood gas analysis results were: pH 7.39; PCO2 54.2 mmHg; P O2 47 mmHg. Nocturnal polisomnography showed an apnea/hypopnea index (AHI) of 31 episodes/hour. Upper airway collapse was overcome by a nasal continuous positive airway pressure (nCPAP) of 14 cmH2O. weight loss obtained by a hypocaloric diet was not accompanied by any OSAS improvement. After thyroidectomy, a nCPAP of 4 cmH2O was sufficient to prevent upper airway closure. Discontinuation of nCPAP treatment for 4 consecutive nights did not determine worsening of sleep apnea symptoms, nor a worsening of overnight oxymetry. A new polysomnography carried out after 4 nights off nCPAP showed an AHI of 33 episodes/hour. OSAS should be suspected in patients with large goitres. Decisions regarding discontinuation of nCPAP treatment after thyroidectomy should be based on polisomnographic results.
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ranking = 25.296088681464
keywords = airway obstruction, airway, obstruction
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10/17. Retrotracheal goiter.

    Retrotracheal extension of a goiter, though rare usually causes respiratory compromise, dysphagia or vascular obstruction. We have described an asymptomatic patient with a large retrotracheal goiter resected via a collar incision.
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ranking = 0.6286306984827
keywords = obstruction
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