Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 247
Filtrar
1.
Medicine (Baltimore) ; 98(42): e17650, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626151

RESUMO

INTRODUCTION: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. PATIENT CONCERNS: Here we describe the anesthetic management of a 67-year-old man with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms. The patient presented with progressive dyspnea that was aggravated in the supine position and was scheduled for total thyroidectomy. DIAGNOSIS: Preoperative computed tomography showed a large goiter extending into the thoracic cavity, with diffuse segmental tracheal narrowing for 6 cm. The diameter at the narrowest portion of the trachea was 4.29 mm. INTERVENTIONS: Before the induction of general anesthesia, we applied extracorporeal membrane oxygenation (ECMO) in preparation for potential difficulties in securing the airway during general anesthesia. Subsequently, anesthesia was successfully induced and maintained. OUTCOMES: After the surgical procedure, fiberoptic bronchoscopy and chest radiography showed resolution of the tracheal narrowing. ECMO was weaned 2 hours after the surgery, and the patient was extubated on the first postoperative day. He was discharged without any complication. CONCLUSION: The findings from this case suggest that the use of ECMO before the induction of general anesthesia is a safe method for maintaining oxygenation in patients with severe tracheal obstruction.


Assuntos
Anestesia Geral/métodos , Oxigenação por Membrana Extracorpórea/métodos , Bócio Subesternal/cirurgia , Posicionamento do Paciente , Tireoidectomia/métodos , Estenose Traqueal/cirurgia , Idoso , Broncoscopia/métodos , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico , Humanos , Intubação Intratraqueal/métodos , Masculino , Radiografia Torácica , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Estenose Traqueal/complicações
2.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383679

RESUMO

Acute airway obstruction in pregnancy remains a challenge to manage. Failure of appropriate and timely airway management may lead to maternal morbidity and mortality such as aspiration pneumonitis or worst hypoxaemic cardiopulmonary arrest. 1 As pregnancy may exacerbate asthma attacks, parturient presenting with wheezing or shortness of breath will commonly be treated as suffering from an asthmatic attack. 2 However, it is important to note other possible differential diagnoses. Thyroid disease is relatively common in women of childbearing age. The thyroid gland undergoes several changes during pregnancy, which may lead to altered function as well as gland enlargement and cause upper airway obstruction and symptoms similar to a bronchial asthma attack. 3 4 With that in mind, we report a case of a parturient with long-standing goitre in her second trimester who presented to our institution with acute respiratory symptoms and cardiopulmonary arrest.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Asma/diagnóstico , Bócio Subesternal/diagnóstico , Complicações na Gravidez/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Diagnóstico Diferencial , Feminino , Bócio Subesternal/complicações , Humanos , Gravidez , Complicações na Gravidez/etiologia
3.
BMJ Case Rep ; 12(4)2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31028051

RESUMO

A 51-year-old man presented acutely with recurrent bouts of coughing associated with transient and brief loss of consciousness consistent with cough syncope, mild stridor and a recent history of a respiratory tract infection. A chest X-ray demonstrated tracheal narrowing. His D-dimer was negative. A non-contrast CT scan of the chest demonstrated a large retrosternal goitre causing tracheal compression, and further investigation with a contrast-enhanced CT scan of the neck and chest demonstrated an incidental finding of a large pulmonary embolus (PE). The full extent of the PE was determined through performing a CT pulmonary angiography. Doppler ultrasound demonstrated a left leg deep vein thrombosis as the primary cause of the PE. His cough syncope improved in response to anticoagulation treatment, to the point where he could be safely discharged home. He had a further significant improvement in symptoms following an elective hemithyroidectomy for retrosternal goitre.


Assuntos
Angiografia por Tomografia Computadorizada , Tosse/fisiopatologia , Bócio Subesternal/fisiopatologia , Embolia Pulmonar/fisiopatologia , Síncope/fisiopatologia , Doenças da Traqueia/fisiopatologia , Anticoagulantes/uso terapêutico , Tosse/complicações , Bócio Subesternal/complicações , Bócio Subesternal/cirurgia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/patologia , Síncope/etiologia , Tireoidectomia , Doenças da Traqueia/complicações , Doenças da Traqueia/cirurgia , Resultado do Tratamento
4.
Auris Nasus Larynx ; 46(2): 246-251, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30055961

RESUMO

OBJECTIVE: Descending goiter has been a focus of controversy in thyroid surgery until nowadays. This study aims to investigate the diagnosis and treatment options of thyroid goiters extending into the mediastinum and the thoracic cavity. METHODS AND MATERIALS: A retrospective study was conducted assessing all cases of substernal goiter managed in a tertiary care referral center within 22 years. Demographics, clinical, operative, anatomical, and pathological data of the patients were recorded and analyzed. RESULTS: Among 3.028 total thyroidectomies, 212 procedures for substernal goiters were studied. All cases underwent total thyroidectomy. The surgical approach was cervical in all but two cases. A very low rate of complications and zero mortality were noted. Incidence of malignancy on permanent histology was 16%. CONCLUSION: Descending goiter constitutes a major indication for thyroid surgery. The overwhelming majority of descending goiters may be managed surgically through a neck incision. In experienced hands good results with low morbidity should be expected. Such cases should be considered as challenging, however, and therefore management in a referral center may be necessary in order to ensure optimal results.


Assuntos
Bócio Subesternal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Câncer Papilífero da Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Tireoidectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Feminino , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico , Bócio Subesternal/epidemiologia , Humanos , Hipocalcemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Monitorização Neurofisiológica , Radiografia Torácica , Recuperação de Função Fisiológica , Estudos Retrospectivos , Esternotomia , Tomografia Computadorizada por Raios X , Ultrassonografia , Paralisia das Pregas Vocais/epidemiologia , Adulto Jovem
6.
Kyobu Geka ; 71(5): 392-395, 2018 May.
Artigo em Japonês | MEDLINE | ID: mdl-29755094

RESUMO

An 81-year-old woman with acute respiratory distress was referred to our hospital. Computed tomography showed a large mass in the upper mediastinum with severe tracheal stenosis. Endotracheal intubation was performed under the preparation of extracorporeal membrane oxygenation and high-frequency jet ventilation, and the tumor was completely removed. The pathologic diagnosis was a goiter. Post-operatively, respiratory distress disappeared. No tumor recurrences have been noted for more than 2 years after surgery.


Assuntos
Bócio Subesternal/cirurgia , Insuficiência Respiratória/terapia , Estenose Traqueal/cirurgia , Idoso de 80 Anos ou mais , Emergências , Oxigenação por Membrana Extracorpórea , Feminino , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico por imagem , Ventilação em Jatos de Alta Frequência , Humanos , Intubação Intratraqueal , Insuficiência Respiratória/etiologia , Tomografia Computadorizada por Raios X , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/etiologia
7.
Ann Ital Chir ; 62017 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-28904244

RESUMO

Tracheobronchopathia osteochondroplastica (TPO) is a rare pathology characterized by a progressive segmentary stenosis of the respiratory tract due to proliferation of osteocartilagineous nodules in the lumen of the distal part of the trachea and large bronchial trunks. Prognosis is usually benign, but some cases with an acute progression and a lethal outcome have been described. Clinical presentation is non specific, the chest x-ray is generally normal and there are not typical radiological signs of suspicion: diagnosis of TPO is usually incidental. We report a case of TPO associated with a retrosternal recurrent goiter. The CT scan conducted to evaluate the extension and the vascular relationships showed the characteristic lesions of the TPO with a segmental stenosis of the trachea greater than 70%. A bronchofiberoscopy confirmed the suspect of TPO. To date, the clinical studies carried out do not show a certain etiology, but all agree that chronic damage or chronic inflammations could be the cause of the onset of structural anomalies of the respiratory tract In literature, there is only a report which describes an association between TPO and thyroid pathology. It is obscure whatever these disease could be etiologically or fortuitously associated but a relationship cannot be completely excluded. Surgeons, anesthetists and radiologists which deal with thyroid pathology must recognize the disease, especially in the presence of bulky retrosternal goiters, to make a correct diagnosis and provide adequate perioperative management. KEY WORDS: Mediastinal goiter, Osteocartilagineous Nodules, Tracheal Stenosis, Total Thyroidectomy, Tracheobronchopathia Osteochondroplastica.


Assuntos
Bócio Subesternal/complicações , Osteocondrodisplasias/complicações , Doenças da Traqueia/complicações , Broncoscopia , Causalidade , Bócio Subesternal/cirurgia , Humanos , Achados Incidentais , Osteocondrodisplasias/diagnóstico por imagem , Osteocondrodisplasias/cirurgia , Tomografia Computadorizada por Raios X , Doenças da Traqueia/diagnóstico por imagem , Doenças da Traqueia/cirurgia
9.
Arch Endocrinol Metab ; 61(4): 348-353, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28658344

RESUMO

OBJECTIVE: This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. SUBJECTS AND METHODS: A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. RESULTS: The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. CONCLUSION: This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.


Assuntos
Bócio Subesternal/epidemiologia , Refluxo Laringofaríngeo/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Bócio/complicações , Bócio/epidemiologia , Bócio/fisiopatologia , Bócio/cirurgia , Bócio Subesternal/complicações , Bócio Subesternal/fisiopatologia , Bócio Subesternal/cirurgia , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico por imagem , Laringoscopia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Tireoidectomia
11.
Auris Nasus Larynx ; 44(1): 111-115, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26995097

RESUMO

OBJECTIVE: Substernal goiters are classified as primary or secondary intrathoracic goiters. Here, we report the diagnosis, symptoms, treatment, and postoperative complications of 44 substernal goiters (2 primary mediastinal goiter and 42 secondary mediastinal goiters). METHODS: A retrospective chart review of 351 patients undergoing thyroidectomy at the Department of Otolaryngology-Head and Neck Surgery of the Tokyo Metropolitan Tama Medical Center. Between 2009 and 2015, 44 patients underwent surgery for substernal goiter. RESULTS: The frequency of primary and secondary mediastinal goiters was 0.5% and 11.9%, respectively. The preoperative symptoms were neck mass, dyspnea, and dysphagia. Eight patients were asymptomatic. Thirty-nine patients had benign masses and 5 patients had malignant masses. Most patients were operated on for adenomatous goiters (52.2%). In ten cases beyond the aortic arch, the tumors were benign and there were eight cases of adenomatous goiter. All patients underwent a successful transcervical incision without sternotomy. Even the primary intrathoracic goiters were extracted after total thyroidectomy via the cervical approach without complications. Although one case showed unilateral recurrent nerve paralysis as a postoperative complication, phonetic function improved in 6 postoperative months. No instances of postoperative bleeding or definitive hypoparathyroidism occurred, and tracheostomy was not performed in any of the cases. CONCLUSION: The cervical approach was safely performed in almost all substernal goiters without an extracervical procedure. Selected cases of primary mediastinal goiter may be excised via the cervical approach.


Assuntos
Adenocarcinoma Folicular/cirurgia , Adenoma/cirurgia , Carcinoma/cirurgia , Bócio Subesternal/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adenocarcinoma Folicular/complicações , Adenoma/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/complicações , Carcinoma Papilar , Tosse/etiologia , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Feminino , Bócio Subesternal/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/complicações
14.
Tokai J Exp Clin Med ; 41(4): 181-184, 2016 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-27988915

RESUMO

BACKGROUND: Substernal thyrotoxic multinodular goiter (MNG) shows signs and symptoms as a result of compression of adjacent organs and thyrotoxicosis. However, acute airway obstruction is rarely caused by substernal thyrotoxic MNG. CASE REPORT: We have described a 56-year-old Japanese woman who demonstrated acute airway obstruction because of compression of the airway by substernal thyrotoxic MNG. She had been diagnosed with substernal thyrotoxic MNG 6 years back. However, because she was unwilling to undergo surgery to remove substernal thyrotoxic MNG, she was treated with methimazole. The patient maintained normal thyroid function with this therapy for 6 years. However, after 6 years the patient was admitted to our hospital because of severe dyspnea. Physical examination revealed inspiratory stridor, which indicated an airway obstruction caused by substernal thyrotoxic MNG. Airway intubation and subtotal thyroidectomy were performed. After the surgery, the dyspnea ameliorated. The general condition of the patient remained good 6 months after the surgery. CONCLUSION: This case clearly demonstrates the need for careful monitoring of substernal thyrotoxic MNG, because it may lead to an airway obstruction.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Bócio Nodular/complicações , Bócio Subesternal/complicações , Doença Aguda , Obstrução das Vias Respiratórias/terapia , Feminino , Bócio Nodular/cirurgia , Bócio Subesternal/cirurgia , Humanos , Intubação Intratraqueal , Pessoa de Meia-Idade , Tireoidectomia , Resultado do Tratamento
17.
Chest ; 148(6): e168-e170, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26621294

RESUMO

We report a case of intrathoracic goiter with positive Pemberton sign. Conventional spirometry did not show abnormalities, but arm elevation spirometry with flow-volume loops revealed expiratory flow limitation with a plateau. Clinicians should consider repeating flow-volume loops with arm elevation in all cases of intrathoracic goiter with initially normal loops.


Assuntos
Obstrução das Vias Respiratórias , Bócio Subesternal , Posicionamento do Paciente/métodos , Espirometria/métodos , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Diagnóstico Diferencial , Feminino , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico , Bócio Subesternal/fisiopatologia , Humanos , Ventilação Pulmonar , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos
19.
Indian J Tuberc ; 62(2): 117-20, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26117483

RESUMO

Intrathoracic goitre is an uncommon condition which usually occurs in females in the fifth decade. It can cause compression of several mediastinal structures. A 42-year-old female with goitre since childhood was evaluated for dry cough, occasional wheezing and low grade fever. Imaging showed patchy airspace opacities with cavitation in left lung. Imaging of the neck revealed retrosternal extension of the goitre. Stains and cultures of bronchial aspirate were positive for Mycobacterium tuberculosis. A diagnosis of pulmonary tuberculosis with intrathoracic goitre was established, an unusual association.


Assuntos
Bócio Subesternal/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Adulto , Feminino , Bócio Subesternal/complicações , Humanos , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/complicações
20.
G Chir ; 36(1): 26-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25827666

RESUMO

INTRODUCTION: Tracheal varices are a rare condition but they can be an important source of massive or recurrent haemoptysis. Usually they are related to increased pressure in the pulmonary veins. Mediastinal goiter is often associated to compressive effects on the surrounding structures, including mediastinal vessels with potential superior vena cava syndrome. CASE REPORT: We describe a case, not previously reported in literature, of mediastinal goiter with hemoptysis as first clinical manifestation. Bleeding was attributed to a superior vena cava syndrome associated to a tracheal fragile mucosa with an easily bleeding intramural nodule which was diagnosed as tracheal varices after total thyroidectomy. The nodule in fact disappeared together with the venous hypertensive signs after venous decompression of the mediastinum. CONCLUSIONS: Compressive symptoms including tracheal varices, related to mediastinal goiter, can be treated surgically by total thyroidectomy via cervicotomy and when required with associated median sternotomy.


Assuntos
Bócio Subesternal/cirurgia , Tireoidectomia , Traqueia/irrigação sanguínea , Varizes/etiologia , Bócio Subesternal/complicações , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Esterno/cirurgia , Tireoidectomia/métodos , Resultado do Tratamento , Varizes/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA