Early CT scan prevents airway obstruction in a thyroidectomy case complicated by postoperative hematoma: A case report.

Abstract

Introduction: Among patients undergoing thyroid or head and neck surgery, the incidence of postoperative hemorrhage is reported to range between 0.36 % and 4.2 %. Postoperative bleeding in the neck can lead to severe complications if not promptly addressed.

Presentation of case: The patient in this case was a man in his 50s, who was being treated for T3-dominant Basedow's disease with medication at the endocrinology department of our hospital. However, owing to the ineffectiveness of drug therapy in controlling the condition, the patient was referred to our department for surgery. Approximately 18 h after undergoing a thyroidectomy, the patient suddenly complained of dyspnea. Laryngeal fiberoptic examination showed no signs of laryngeal edema or recurrent nerve palsy. However, a neck CT scan revealed a hematoma at the surgical site, necessitating emergency surgery. During the operation, hematomas were found in both the superficial and deep layers of the surgical area. Arterial bleeding from the left side of the thyroid cartilage was confirmed, and the branches of the superior laryngeal artery were ligated to stop the bleeding.

Discussion: Hematoma formation in a narrow space, particularly in the neck, can obstruct large vessels such as the internal jugular veins, compromising venous return. This may result in laryngeal edema, asphyxia, and, in the worst-case scenario, death.

Conclusion: An early neck CT scan revealed a subcutaneous neck hematoma caused by postoperative bleeding, leading to emergency hematoma removal, hemostasis, and tracheotomy, which successfully prevented airway obstruction.