Forgotten Goiter Presenting As Acute Respiratory Distress Following a Thyroidectomy: A Case Report.

Airway complications account for a significant amount of post-thyroidectomy complications. Forgotten goiter is a residual thyroid mass left after total thyroidectomy, an event already depicted in the literature. Clinical presentation is diverse, ranging from asymptomatic tracheal deviation to symptoms caused by hormonally active thyroid tissue or airway obstruction due to mass effect. However, it has never been documented as the cause of acute respiratory distress following thyroid surgery. We report the case of a 65-year-old female undergoing left hemithyroidectomy due to long-standing substernal goiter. Anesthesia induction and surgery were uneventful. On extubation, the patient presented with acute respiratory distress requiring prompt airway management. A computed tomography scan revealed residual intrathoracic goiter resulting in significant airway compression. Therefore, although a rare event, a forgotten goiter should be considered by a multidisciplinary team when patients undergoing surgery for substernal goiter develop acute postoperative airway obstruction after common post-thyroidectomy complications have been excluded.

Cerebrospinal Fluid Cutaneous Fistula Following Neuraxial Anesthesia for Cesarean Delivery.

Cerebrospinal fluid (CSF) cutaneous fistula is an unusual but potentially serious complication of neuraxial procedures. While combined spinal-epidural (CSE) technique or spinal/epidural techniques alone are standard in obstetric anesthesia, subsequent persistent CSF leak is rarely reported in the obstetric population. Clinical presentation ranges from asymptomatic states and only abnormal leakage through the puncture site to severe cases with meningitis or subdural hematoma. Both conservative and invasive approaches are suitable for management, but no formal guidelines on how to diagnose and manage this condition are available, and hence clinicians have to rely on their experience. We present a case of a 35-year-old parturient scheduled for an elective cesarean delivery with a persistent CSF leak three days after epidural catheter removal. The leakage was managed with both suturing of the skin site and conservative methods such as hydration, bed rest, and oral analgesics, with no adverse effects for the patient.