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

Abstract

Introduction: Benign cervical goiters rarely cause acute airway obstruction.

Case presentation: 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.

Conclusion: 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.

Figure 1

Large benign multi-nodular goiter. The figure illustrates the size of the large multi-nodular goiter that our patient presented with. This goiter measured 14×11 cm (right lobe) and 11×8 cm (left lobe). No retrosternal goiter was found on examination. Our patient was intubated and on the ventilator with a central line in place on the right.

Figure 2

A computed tomography (CT) scan at the level of C7 showing the endotracheal tube flush with the wall of the trachea. The diameter of the tracheal lumen measured 7.5 mm with the endotracheal tube in situ maintaining its patency. Compare the tracheal diameter in this image with Figure 3.

Figure 3

A computed tomography (CT) scan at the level of T2 showing the endotracheal tube situated within the tracheal lumen. The tracheal diameter was 2 cm at this level. No retrosternal tracheal compression was evident as compared to Figure 2. There was mild retrosternal extension on the left down to the level of the great vessels. A central venous line was noted on the right.