# Tracheal Obstruction by Thyroid Gland Extension into the Trachea after Blunt Tracheal Transection

## TL;DR

A rare case of tracheal obstruction caused by thyroid gland extension after blunt trauma was successfully treated with ECMO and surgery.

## Contribution

Presents a novel case of tracheal obstruction due to thyroid gland extension following blunt trauma and its successful management with ECMO and surgical repair.

## Key findings

- Tracheal obstruction by thyroid gland extension after blunt trauma can be managed with venovenous ECMO and surgery.
- Computed tomography and bronchoscopy were key in diagnosing the endotracheal mass.
- Successful tracheal anastomosis and patient recovery were achieved following surgical intervention.

## Abstract

Tracheal injuries due to blunt force trauma are rare yet life-threatening conditions, comprising only 4% of chest trauma cases. Diagnosis is often delayed, increasing the risk of severe complications. This report describes a unique case of tracheal obstruction caused by thyroid gland extension into the trachea following blunt trauma, which was managed successfully with venovenous extracorporeal membrane oxygenation (ECMO) and surgery.

A 50-year-old male presented with severe respiratory distress following a seizure-induced fall at his residence. On arrival at the hospital, the patient was in respiratory failure with an SpO2 of 92% on a 10 L/min reservoir mask, had severe subcutaneous emphysema, and an upper airway stridor. Computed tomography revealed mediastinal emphysema and a 13-mm endotracheal mass obstructing the trachea. Flexible bronchoscopy indicated a suspected tracheal tumor, but intubation was unsuccessful due to bleeding and obstruction. Emergency tracheostomy was considered but deemed risky because imaging showed that the distal trachea was located near the sternum’s suprasternal margin. The patient’s respiratory distress worsened, and his SpO2 dropped to 86%. Venovenous ECMO was then administered, stabilizing his condition. Surgical intervention was performed to address the endotracheal mass and tracheal injury. A transverse neck incision allowed dissection and identification of the tracheal injury, revealing the inferior thyroid gland which extended into the tracheal lumen. Pathological examination confirmed the endotracheal mass as normal thyroid tissue. Tracheal anastomosis was successfully completed, and the patient was discharged on postoperative day 10 without complications.

This case highlights an unusual presentation of tracheal obstruction caused by thyroid gland extension into the trachea following blunt trauma. Rapid initiation of ECMO enabled successful airway management and surgical repair. Recognizing atypical presentations of tracheal injuries is critical in trauma cases, as prompt intervention can prevent further complications and improve patient outcomes. This case underscores the importance of tailored airway management and the potential role of ECMO in cases of similar complex airway obstructions.