Calogero Cristina G, Miller Andrew C, Greenberg Marna Rayl
Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, USF MCOM, CC & I-78, Allentown, PA 18103, USA.
Case Rep Emerg Med. 2015;2015:789076. doi: 10.1155/2015/789076. Epub 2015 Dec 24.
Inferior thyroid artery (ITA) rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Emergent computed tomography revealed a large retropharyngeal hematoma, with active arterial extravasation that was thought to be arising from the thyrocervical trunk on the left. The hematoma measured approximately 6.7 cm transversely and 3.2 cm anteroposteriorly and extended from the level of the lower nasopharynx, down the neck into the retropharyngeal and danger space and into the mediastinum posterior to the esophagus, overall approximately 25 cm. The larynx was deviated anteriorly and there was esophageal compression. An emergent arteriogram and catheterization confirmed bleeding from branches of the ITA, and successful embolization was performed. It is important to recognize the ITA rupture as a potential etiology of an acute airway compromise. In emergent situations, while securing an airway is a priority, rapidly initiating diagnostic testing to confirm the diagnosis and arranging for arterial embolization can be life-saving.
甲状腺下动脉（ITA）破裂罕见，可能进展为危及生命的情况。我们报告一名患者，他在一次晕厥和头晕发作后前往急诊科，期间发生机械性跌倒，导致左前额擦伤和血肿。患者出现吞咽困难和颈部前方肿胀，并迅速进展为气道受压，需要进行气管插管。急诊计算机断层扫描显示巨大的咽后血肿，伴有活动性动脉外渗，推测源自左侧的甲状颈干。血肿横向约6.7厘米，前后径约3.2厘米，从鼻咽下部水平向下延伸至颈部，进入咽后间隙和危险间隙，并进入食管后方的纵隔，总长约25厘米。喉部向前移位，食管受压。急诊动脉造影和导管插入术证实出血来自ITA分支，并成功进行了栓塞。认识到ITA破裂是急性气道受压的潜在病因很重要。在紧急情况下，虽然确保气道安全是首要任务，但迅速启动诊断测试以确诊并安排动脉栓塞可能挽救生命。
