An Adolescent with Transient Hyperthyroxinemia after Blunt Trauma to Head and Neck

Background. Thyroid storm is a well-known complication of surgical procedures in the lower neck, but is rare after a blunt neck trauma. The cases described previously have mainly focussed on adults with pre-existent thyroid disease. In this case report, we describe the disease course of a previously healthy adolescent who had asymptomatic hyperthyroxinemia after a blunt trauma of the jaw and neck. Case Presentation. A 17-year-old girl presented at our emergency department after she fell on her head while roller blading. On physical examination, among other injuries, she had a swelling in the lower neck, which appeared to involve the thyroid gland. Subsequent laboratory analysis was indicative of primary hyperthyroxinemia, with a free T4 of 59 pmol/L (reference range: 12–22) and a TSH of 0.46 mU/L (reference range: 0.5–4.3), but the patient had no symptoms fitting with this. Four weeks after the initial presentation, the patient reported only complaints regarding tenderness in the jaw and neck region. She was no longer hyperthyroidic on biochemical evaluation (with a free T4 level of 15.6 pmol/L and a TSH level of 0.33 mU/L), and antibodies against thyroid peroxidase or TSH receptor were not present. Conclusions. This case might indicate that hyperthyroxinemia following a neck trauma may go unnoticed if hyperthyroid symptoms are mild or absent and thyroid function tests are not performed.

A clinical case of successful treatment of complete abruption of the trachea from the larynx

Tracheobronchial injuries as a consequence of chest blunt trauma are rare. Blunt traumas of the cervical part of the trachea are a rarer pathology presenting a serious diagnostic problem for a clinician. Traumas of the larynx and the trachea account for 40 to 80% of lethality. The tracheas cervical part is vulnerable despite that it is covered with the neck muscles, spine, clavicles, and mandible. In cut/stab wounds, the tracheas cervical part is often damaged together with the adjacent structures. In blunt trauma, under a direct action of a traumatizing agent, the mobile trachea displaces toward the spine, accompanied by damage to the tracheal cartilages, its membranous part, and the soft surrounding tissues with preservation of the integrity of the skin. Tracheal ruptures along the distance up to 1 cm from the cricoid cartilage account for not more than 4% of all tracheal ruptures. A complete tracheal rupture and its abruption from the larynx are extremely rare pathology. Because of severe respiratory disorders, most victims die at the site where their injury occurred. This article presents a clinical case of the successful treatment of patient Z., 41 years of age, with complete tracheal abruption from the larynx. The cause of tracheal damage was blunt neck trauma in a traffic accident. A peculiarity of this clinical case was that the victim arrived at a specialized thoracic surgery unit with a functioning tracheostomy two days after the trauma. Conclusion. Tracheal trauma is a potentially fatal condition. Therefore, early diagnosis of tracheobronchial damage is essential since it permits timely surgical intervention and diminished risk of lethal outcome. When dealing with patients with trauma of the head, neck, and chest with non-corresponding clinical data and the absence of effective recommended standard therapeutic measures, a clinician should become alert and exclude the tracheal and bronchial damage. X-ray computed tomography and fibrotracheobronchoscopy are strongly recommended as reliable methods to diagnose tracheobronchial damages. In a surgical intervention, it is necessary to perform the primary suture on the trachea, avoid preventive tracheostomy, and delay interventions associated with poorer prognosis and a high complication rate.

A Case Report of a Soldier with Combined Injuries to the Trachea and Esophagus After Blunt Neck Trauma Successfully Treated Through an Emergency Operation

Background: Survival following blunt neck trauma that results in a combination of tracheal plus esophageal injury is unusual. Here we describe a case of young soldier who suffered combined injuries to the trachea and esophagus after a secondary injury involving a metal bar. Case Presentation: A 21 years old soldier who suffered from a daily training injury complained of neck ecchymosis with subcutaneous emphysema. The chest CT revealed that paratracheal adipose tissue had moved into the trachea and with massive pneumomediastinum and subcutaneous emphysema. We made a suspected diagnosis of tracheal injury because of the pneumomediastinum. Subsequently, the tracheoscopy revealed a 2-3 cm linear tear of the proximal trachea, with adipose tissue extending into the trachea. Twelve hours after the accident, an emergency surgery was performed. Combined injuries of the trachea plus esophagus were found by accident during the operation. The trachea as well as esophagus was repaired with simple interrupted silk sutures. The patient showed good postoperative recovery and was discharged with no complications.Conclusion: Combined blunt traumatic injuries to the laryngotrachea as well as esophagus are rare. Although uncommon and a diagnostic and management challenge, the illustrated case resulted in excellent outcome.