Öz
Giriş: Plonjan guatr, tiroid bezinin mediasten içinde uzanması
olarak tanımlanır. Hastalarda nadiren de olsa vokal kord paralizisi,
büyük damar basısına bağlı vena kava süperior sendromu ve
horner sendromu görülebilir.
Olgu Sunumu: Yetmiş yedi yaşındaki bayan hasta, nefes darlığı,
yüzde kızarıklık ve şişlik nedeniyle acil servise başvurdu. Hastanın
fizik muayenesinde; nabız: 135/dk, tansiyon arteriyal: 140/90
mmHg, solunum sayısı: 28/dakika, SpO2
: %88 idi. Boyun venöz
dolgunluğu artmış, her iki troid lobu palpabl, sağ akciğerde
solunum sesleri azalmıştı. Kontrastlı toraks tomografisinde (CT)
Plonjan guatr izlendi. Tedavide nazal O2
4 L/dk, budenosid 200
mcg 3X2 puff, metilprednizolon 250 mg iv. başlandı.
Sonuç: Dispne ile gelen hastalarda retrosternal (plonjan) guatr
olasılığı da düşünülmelidir.
Anahtar Kelimeler
Kaynakça
- Hashmi SM, Premachandra DJ, Bennett AM, Parry W. Management of retrosternal goitres: results of early surgical intervention to prevent airway morbidity, and a review of the English literature. J Laryngology Otology 2006; 120: 644-9.
- Ríos A, Rodríguez JM, Canteras M, Galindo PJ, Tebar FJ, Parrilla P. Surgical management of multinoduler goiter with compression symptoms. Arch Surg 2005; 140: 49-53. [CrossRef]
- Grainger J, Saravanappa N, D’Souza A, Wilcock D, Wilson PS. The surgical approach to retrosternal goiters: the role of computerized tomography. Otolaryngol Head Neck Surg 2005; 132: 849-51. [CrossRef]
- Tsakiridis K, Visouli AN, Zarogoulidis P, Karapantzos E, Mpakas A, Machairiotis N, et al. Resection of a giant bilateral retrovascular intrathoracic goiter causing severe upper airway obstruction, 2 years after subtotal thyroidectomy: a case report and review of the literature. J Thorac Dis. 2012; 4: 41-8.
- Farivar AS, Lukanich JM. Resection of Substernal Goiter. In: Sugarbaker D, Bueno R, Krasna MJ, Mentzer SJ, Zellos L. (eds). Adult Chest Surgery, 1st ed. New York City: McGraw-Hill; 2009. p 1-33.
- Abboud B, Sleilaty G, Mallak N, Abou Zeid H, Tabchy B. Morbidity and mortality of thyroidectomy for substernal goiter. Head Neck 2010; 32: 744-9.
- Pieracci FM, Fahey TJ 3rd. Substernal thyroidectomy is associated with increased morbidity and mortality as compared with conventional cervical thyroidectomy. J Am Coll Surg 2007; 205: 1-7. [CrossRef]
- Ket S, Özbudak Ö, Özdemir T, Dertsiz L. Trakeal obstrüksiyonu olan ve akut solunum yetmezliği gelişen posterior dev mediastinal guatrlı bir olgu. Akciğer Arşivi 2005; 6: 84-5.
- Madjar S, Weissberg D. Retrosternal goiter. Chest 1995; 108: 78-82. [CrossRef]
- Yorgancılar E, Yıldırım M, Gün R, Bakır S, Topçu İ. Substernal Guatra Yaklaşım. KBB-Forum 2011; 10: 40-5.
Öz
Introduction: Substernal thyroid goiter is defined as extension of the thyroid gland into the mediastinum. Vocal cord paralysis, vena cava superior syndrome due to the compression on major vessels, and Horner syndrome can be rarely seen in patients.Case Report: A 77-year-old female patient presented to our emergency department with complaints of dyspnea, flushing, and edema on her face. Her vital signs were as follows: BP: 140/90 mm Hg, HR: 135 bpm, respiratory rate: 28 per minute, and SpO2: 88%. On her physical examination, there was increased jugular venous distension, both thyroid lobes were palpable, and breath sounds decreased in the right lung. A contrast-enhanced pulmonary computed tomography (CT) was planned, and substernal goiter was seen on CT. Then, 4 L/min supplemental O2, 2 puffs of 200 mcg budenoside 3 times a day and 250 mg IV methylprednisolone therapy were started.Conclusion: In patients presenting with dyspnea, retrosternal (substernal) goiter should also be considered
Anahtar Kelimeler
Substernal goiter vena cava superior syndrome emergency service
Kaynakça
- Hashmi SM, Premachandra DJ, Bennett AM, Parry W. Management of retrosternal goitres: results of early surgical intervention to prevent airway morbidity, and a review of the English literature. J Laryngology Otology 2006; 120: 644-9.
- Ríos A, Rodríguez JM, Canteras M, Galindo PJ, Tebar FJ, Parrilla P. Surgical management of multinoduler goiter with compression symptoms. Arch Surg 2005; 140: 49-53. [CrossRef]
- Grainger J, Saravanappa N, D’Souza A, Wilcock D, Wilson PS. The surgical approach to retrosternal goiters: the role of computerized tomography. Otolaryngol Head Neck Surg 2005; 132: 849-51. [CrossRef]
- Tsakiridis K, Visouli AN, Zarogoulidis P, Karapantzos E, Mpakas A, Machairiotis N, et al. Resection of a giant bilateral retrovascular intrathoracic goiter causing severe upper airway obstruction, 2 years after subtotal thyroidectomy: a case report and review of the literature. J Thorac Dis. 2012; 4: 41-8.
- Farivar AS, Lukanich JM. Resection of Substernal Goiter. In: Sugarbaker D, Bueno R, Krasna MJ, Mentzer SJ, Zellos L. (eds). Adult Chest Surgery, 1st ed. New York City: McGraw-Hill; 2009. p 1-33.
- Abboud B, Sleilaty G, Mallak N, Abou Zeid H, Tabchy B. Morbidity and mortality of thyroidectomy for substernal goiter. Head Neck 2010; 32: 744-9.
- Pieracci FM, Fahey TJ 3rd. Substernal thyroidectomy is associated with increased morbidity and mortality as compared with conventional cervical thyroidectomy. J Am Coll Surg 2007; 205: 1-7. [CrossRef]
- Ket S, Özbudak Ö, Özdemir T, Dertsiz L. Trakeal obstrüksiyonu olan ve akut solunum yetmezliği gelişen posterior dev mediastinal guatrlı bir olgu. Akciğer Arşivi 2005; 6: 84-5.
- Madjar S, Weissberg D. Retrosternal goiter. Chest 1995; 108: 78-82. [CrossRef]
- Yorgancılar E, Yıldırım M, Gün R, Bakır S, Topçu İ. Substernal Guatra Yaklaşım. KBB-Forum 2011; 10: 40-5.
Ayrıntılar
| Diğer ID | JA78JZ23KF |
|---|---|
| Bölüm | Case Report |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2014 |
| Gönderilme Tarihi | 1 Haziran 2014 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 5 Sayı: 6 |