病例报告：一例Graves病患者中疑似甲状腺乳头状肿瘤破裂并出现气道狭窄但无呼吸窘迫。

文献信息

中文摘要

本病例报告描述了一名55岁女性，在颈部出现“爆裂”感后表现为急性吞咽困难和颈部肿胀。CT和MRI显示一个大的咽后囊性肿块和左侧甲状腺叶肿块，导致气道移位。尽管柔性鼻咽喉镜检查显示口咽和声门上气道明显消失，患者仍无呼吸窘迫症状。随后的超声引导下细针穿刺活检诊断为恶性甲状腺乳头状癌。同时，发现此前未诊断的Graves病。临床表现被归因于恶性甲状腺肿瘤的疑似破裂或出血，导致血清血液性液体积聚和炎性水肿。患者接受大剂量类固醇和静脉抗生素治疗，气道水肿得到改善。她在整个住院过程中从未出现喘鸣或呼吸困难，随后接受了全甲状腺切除术和颈部清扫术。本病例强调了甲状腺恶性肿瘤可能以疑似自发性破裂或出血导致气道消失为表现，并提出Graves病是否因血管增多而使患者面临这种表现的额外风险。

英文摘要

This case report describes a 55-year-old woman presenting with acute dysphagia and neck swelling after a "popping" sensation in her neck. CT and MRI revealed a large retropharyngeal cystic mass and a left thyroid lobe mass, causing airway displacement. Despite significant effacement of the oropharyngeal and supraglottic airway on flexible nasopharyngolaryngoscopy, the patient remained asymptomatic regarding respiratory distress. Subsequent ultrasound-guided fine needle aspiration biopsy diagnosed malignant papillary thyroid carcinoma. Concurrently, previously undiagnosed Graves' disease was identified. The clinical presentation was attributed to suspected rupture or hemorrhage of the malignant thyroid tumor, leading to a serosanguineous fluid collection and inflammatory edema. The patient was managed with high-dose steroids and intravenous antibiotics, resulting in improved airway edema. She never developed stridor or dyspnea throughout her hospital course and later underwent a total thyroidectomy with neck dissection. This case highlights the potential for a thyroid malignancy to present with suspected spontaneous rupture or hemorrhage causing airway effacement and raises the question of whether Graves' disease, due to increased vascularity, put patients at additional risk of this presentation.