Emergency management of a patient with severe airway obstruction resulting from poorly differentiated thyroid carcinoma: A case report

Abstract

We present a case of a life-threatening almost complete airway obstruction resulting from poorly differentiated thyroid carcinoma in a 48-year-old male. Airway obstruction may lead to unexpected mortality by suffocation and patients with poorly differentiated thyroid carcinoma usually have a fast deterioration and fatal outcome. In the case presented, we describe a safe and effective treatment strategy. Assisted by femoro-femoral cardiopulmonary bypass oxygenation, a tracheal stent was implanted successfully. Following surgery there were no complications, and chemoradiotherapy resulted in the relief of obstructing symptoms and improved the quality of life of the patient. This case indicates that femoro-femoral cardiopulmonary bypass provides adequate oxygen support to undergo further management and that tracheal stent implant is an effective emergent measure to relieve severe airway obstruction in patients with poorly differentiated thyroid carcinoma.

Figure 1.

CT scan showing the tumor had compressed and invaded the trachea. The narrowest stenosis was 0.3 cm in diameter (Mar. 2, 2011). CT, computed tomography.

Figure 2.

Chest radiograph scan showing the position of the tracheal stent (Mar. 10, 2011).

Figure 3.

CT scan after two cycles of concurrent chemoradiotherapy showing that the stent was successfully implanted and open to maintain patency of the tracheal lumen (May 2, 2011). CT, computed tomography.

Figure 4.

CT images six months after surgery, showing that the airway was open and there was no tumor in the trachea (Aug. 31, 2011). CT, computed tomography.

Figure 5.

CT scan ten months after surgery, showing that the thyroid tumor appeared to be more localized and reduced than pre-surgery (Oct. 27, 2011). CT, computed tomography.

Figure 6.

Bronchoscopic examination showed that the airway was smooth around the endobronchial stent (Nov. 2, 2011).