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. 2009:2009:bcr11.2008.1193.
doi: 10.1136/bcr.11.2008.1193. Epub 2009 Sep 15.

Progressive respiratory distress due to neck mass

Raquel F D van la Parra  1 , Jan Kroeze, Jos van Die, Dries Mulder, Arthur van Zanten, David H Tjan
Affiliations

Progressive respiratory distress due to neck mass

Raquel F D van la Parra et al. BMJ Case Rep. 2009.

Abstract

The present report describes the case of an 80-year-old woman who presented at the emergency department with progressive respiratory distress caused by a massive anterior neck mass with tracheal deviation and compression. A CT scan showed diffuse enlargement of the thyroid gland. The patient underwent a left-sided hemithyroidectomy. Pathology unexpectedly revealed a primary thyroid lymphoma. Treatment with prednisone and vincristine was initiated to reduce tumour size and preserve the airway, resulting in rapid volume reduction and airway expansion. Primary thyroid lymphoma is a rare entity that requires adequate diagnosis and rapid initiation of treatment to reduce tumour volume and to prevent airway compromise.

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Figures

Figure 1
Figure 1
Macroscopy. Left-sided hemithyroidectomy mass.
Figure 2
Figure 2
Preoperative CT image. Thyroid mass with tracheal compression.
Figure 3
Figure 3
Postoperative CT image. Post left-sided hemithyroidectomy. Tracheal compression resolved.
Figure 4
Figure 4
Pathology slide. A. Low power magnification (2.5×) of the thyroid surrounded by partly necrotic lymphoid tissue. B. The higher magnification (40×) shows large atypical lymphoid cells, which were positive for CD20 (not shown).
See this image and copyright information in PMC

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