September 29, 2009

SOB with noisy sound

60 years old Malay Lady with history of thyroid carcinoma (undergone surgery to remove the gland two years ago) presented to A&E with shortness of breath and noisy sound for one day duration.

1) Describe the finding in the X-Ray
2) Explain the pathophysiology of the noisy sound
3) Outline the management for this patient


  1. I have no idea what in this x-ray..

    What i think of when hearing thyroidectomy is hypocalcemia.

    But in this case it is likely caused by injury to the Recurrent Laryngeal Nerve on Superior Laryngeal Nerve.

    Bilateral RLN injury is a severe life-threatening complication that results in airway obstruction and requires immediate attention. In this condition, both vocal cords remain in a median or paramedian position. As a result, the patient exhibits inspiratory stridor, dyspnea, tachypnea, and nasal flaring, although the voice is near normal.

  2. take a look again at the x ray. this is soft tissue setting. therefore you can see the mass obstructing the airway.

    thyroid ca has high risk of recurrence.

    the noisy breathing is called stridor, i.e caused by stenosing of upper airway.

    bilateral recurrent nerbe injury can cause vocal cord paralysis and cause severe airway compromise. it is usually detected post surgery after the extubation. therefore, in this case, it is unlikely because it is sudden in onset and a very long time after surgery


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