Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Benign cervical goiters rarely cause acute airway obstruction.</p> <p>Case presentation</p> <p>We report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression.</p> <p>Conclusion</p> <p>Benign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.</p

Predictors of the need for an extracervical approach to intrathoracic goitre

Background: Sternotomy and lateral thoracotomy are required infrequently to remove an intrathoracic goitre (ITG). As few studies have explored the need for an extracervical approach (ECA), the aim of this study was to examine this in a large cohort of patients. Methods: A prospective database of all patients who had surgery for ITG between 2004 and 2016 was interrogated. Patient demographics, preoperative characteristics and type of operation were analysed to identify factors associated with an ECA. Results: Of 237 patients who had surgery for ITG, 29 (12·2 per cent) required an ECA. ITGs below the aortic arch (odds ratio (OR) 10·84; P = 0·004), those with an iceberg shape (OR 59·30; P < 0·001) and revisional surgery (OR 4·83; P = 0·022) were significant preoperative predictors of an ECA. Conclusion: The extent of intrathoracic extension in relation to the aortic arch, iceberg goitre shape and revisional surgery were independent risk factors for ECA. Careful preoperative assessment should take these factors into consideration when determining the optimal surgical approach to ITG

An Unusual Case of Arteriovenous Fistula following Lumbar Disc Repair Presenting with Pulmonary Embolism

Traumatic arteriovenous fistulas (AVF) frequently occur following gunshot injury. Traumatic iliac AVF are uncommon and iliac AVF occurring after lumbar disc operation are rare. There are many causes of pulmonary embolism (PE). Although the most common cause of PE is venous thrombophlebitis of the lower extremities, iliac AV fistula with thrombophlebitis due to lumbar disc operation as a cause of PE are very rare. We describe a patient with iliac AV fistula with common iliac vein thrombophlebitis due to previous lumbar discectomy presenting with PE