MEDIASTINAL EMPHYSEMA AND PNEUMOTHORAX FOLLOWING THYROIDECTOMY. REPORT OF TWO CASES*

Publisher Website
Google Scholar
Abstract
MEDIASTINAL emphysema with pneumothorax, unilateral or bilateral, is an uncommon complication following thyroidectomy but it is a definite possiblity and undoubtedly occurs more frequently than recognized. Of 16 instances reported in the literature, 11 patients died. This mortality is much higher than one would expect from such a complication and would lead one to believe that it occurs more often in an unrecognized and less lethal form. The symptoms, which are primarily those of a tension pneumothorax, appear during or soon after the operation and may lead to death so quickly that the surgeon does not have the time to analyze the situation or even gather together sufficient information from which to make a diagnosis. Furthermore, unless the postmortem pathologist routinely takes premortem roentgenograms of the chest or makes special efforts to rule out pneumothorax, the condition will not be recognized even at the autopsy table. If the autopsy is delayed a number of hours, air in the mediastinum diffuses and may not be discovered. The clinical diagnosis however is not a difficult one to make, providing the surgeon has knowledge of the possibility of its occurrence. This is well exemplified in the following two case reports. The first one, in which the patient developed a mediastinal emphysema with a bilateral pneumothorax a few hours after operation, brought to my attention for the first time the possibility of such a complication. In the second one, symptoms of an alarming nature appeared immediately following operation and would certainly have resulted in death if the intrathoracic tension had not been relieved.