Tracheal ring fracture as a consequence of external laryngeal manipulation during endotracheal intubation.

We report a case of tracheal ring fracture after external laryngeal manipulation for assisting intubation because of difficult laryngoscopy during induction of anesthesia. The patient was a 64-year-old female suffering from a large multinodular goiter scheduled to undergo general anesthesia with endotracheal intubation for thyroidectomy. Laryngoscopy was performed, which did not visualize the glottis. With application of forceful external laryngeal manipulation, intubation was successfully achieved on the third attempt. But on skin incision and tissue exposure, a single fractured site on the second tracheal ring was noted. Fiberoptic bronchoscopy was performed and showed the tracheal mucosa remaining unmolested without endotracheal lesion or cartilage dislodgement into the trachea. The operation was carried out uneventfully and the fracture was treated conservatively. After extubation, the patient recovered smoothly and had no symptoms suggestive of tracheal narrowing or hoarseness of voice. Neck computed tomography and fiberoptic bronchoscopy were performed postoperatively, both of which showed normal tracheal ring alignment without evidence of edema or hematoma. The patient was discharged 3 days after operation. At the 3-month follow-up, she displayed good airway function and phonation. After review of her clinical history, we speculated that the tracheal ring fracture was caused by forced external compression of the tracheal cartilage during endotracheal intubation.

Thyroid cancer in pregnancy: a report of 3 cases.

BACKGROUND: Thyroid cancer in pregnancy presents a unique challenge to the thyroid specialist and the obstetrician. We report 3 cases of thyroid cancer diagnosed during pregnancy. CASES: Three cases of papillary thyroid carcinoma were diagnosed during pregnancy, at the 14th, 19th and 40th weeks of gestation. The first 2 cases underwent thyroidectomy immediately after the diagnosis, while in the third the operation was deferred until the postpartum period. All 3 women delivered healthy infants, who were 2 months to 8 years of age at the last follow-up visit. CONCLUSION: If well-differentiated thyroid cancer is diagnosed prior to the midtrimester, it is possible to carry out the surgical intervention in the midtrimester. During late pregnancy, resection after delivery is the option of choice. There is no indication for termination of pregnancy.

Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for cancer screening in healthy subjects.

The aim of this study was to define the clinical prevalence and rate of malignancy of focal thyroid incidentaloma in a relatively large number of individuals with application of 18F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) in asymptomatic individuals. The subjects consisted of 4803 physical check-up examinees (2638 men, 2165 women; mean age+/-SD, 52.8+/-9 years old) with non-specific medical history. Whole-body FDG PET was performed on all patients. Focal hypermetabolic areas of thyroid, with an intensity equal to or exceeding the level of FDG uptake in the liver, were considered abnormal and interpreted as thyroid incidentaloma. Among the 4803 FDG PET examinations, thyroid incidentaloma was present in 60 examinations, among which, 50 had further examination with ultrasound-guided fine-needle aspiration (FNA), revealing 43 benign lesions and 7 papillary carcinomas. Of 7 examinees diagnosed with cancer, 2 had lymph nodes metastasis. The mean and standard deviation of standard uptake value (SUV) in benign and carcinoma was 2.6+/-1.01 and 6.7+/-3.66, respectively. Thyroid incidentaloma identified by FDG-PET occurred with a frequency of 1.2% (60/4803). Of the thyroid incidentalomas that underwent FNA and surgery, 14% (7/50) were found to be malignant. It is possible to differentiate benign from carcinoma of thyroid incidentalomas by the increased rate of glycolysis (SUV) in the carcinoma. The small size and moderate FDG uptake of thyroid incidentalomas per se cannot guarantee low risk in incidentally found thyroid cancers.