Y. Qudah1, J. Crystal1, J. Wade1, T. Davidov1 1Robert Wood Johnson – UMDNJ,General Surgery,New Brunswick, NJ, USA
Introduction: Thyromegaly with tracheal deviation and substernal extension is an indication for surgery in part because of concerns over airway compromise. However, the exact risk is unclear.
Methods: CT scans of the neck or chest from 2009-2017 performed at a single hospital were queried for findings of thyromegaly with substernal extension, tracheal deviation, or tracheal compression. The charts of these patients were retrospectively reviewed to determine whether acute airway compromise with sudden intubation or urgent surgical intervention was required.
Results: A total of 682 scans were queried, revealing 209 patients whose scans demonstrated substernal extension or tracheal deviation or compression. Of 209 patients, 125 patients (60%) were asymptomatic with CT findings incidentally discovered. Eighty-four patients (40%) presented with symptoms including dyspnea, dysphagia, chest pain, neck pain, or visible neck mass. Nineteen patients that had these CT findings required intubation during their hospital stay, of which 18 intubations were emergent. Of these 19 patients, 18 had confounding cardiopulmonary problems. No patients required cricothyroidotomy or urgent tracheostomy. There were no mortalities related to sudden airway compromise. Five patients progressed to surgery, one of whom required sternotomy.
Conclusion: While thyromegaly with substernal extension or tracheal deviation may an indication for thyroidectomy in part to prevent sudden airway compromise, the majority of patients with these CT findings are asymptomatic and only rarely do these patients sustain an airway emergency requiring an intervention.