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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Difficult airway due to cervical haemorrhage caused by spontaneous rupture of a parathyroid adenoma: A case report
Yong-Zheng Han, Yang Zhou, Ying Peng, Jin Zeng, Yu-Qing Zhao, Xiao-Ru Gao, Hong Zeng, Xiang-Yang Guo, Zheng-Qian Li
Yong-Zheng Han, Yang Zhou, Hong Zeng, Xiang-Yang Guo, Zheng-Qian Li, Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
Yong-Zheng Han, Yang Zhou, Hong Zeng, Xiang-Yang Guo, Zheng-Qian Li, Beijing Center, Quality Control and Improvement on Clinical Anesthesia, Beijing 100191, China
Ying Peng, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
Jin Zeng, Department of Otorhinolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
Yu-Qing Zhao, Department of Radiology, Peking University Third Hospital, Beijing 100191, China
Xiao-Ru Gao, Department of Anesthesiology, Haidian Maternal and Child Health Care Hospital, Beijing 100191, China
Author contributions: Han YZ, Zhou Y, Li ZQ contributed to manuscript writing and editing; Peng Y, Zeng J, Zhao YQ, Gao XR contributed to cured the patient and data collection; Zeng H, Guo XY, Li ZQ contributed to conceptualization and supervision; All authors have read and approved the final manuscript.
Supported by Key Clinical Projects of Peking University Third Hospital, No. BYSYZD2021013; and Beijing Haidian District Innovation and transformation project, No. HDCXZHZB2021202.
Informed consent statement: We have obtained the informed consent which was verbal of patients in the study. And we have applied for an informed consent waiver from the Ethics Committee. The study was approved by the ethics committee of Peking University Third Hospital and the reference number was IRB00006761-M2022405.
Conflict-of-interest statement: All the authors declare that they have no conflictof interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist(2016), and the manuscript was prepared and revised according to the CAREChecklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Zheng-Qian Li, PhD, Doctor, Department of Anesthesiology, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China.
zhengqianli@hsc.pku.edu.cn
Received: December 1, 2022
Peer-review started: December 1, 2022
First decision: December 20, 2022
Revised: December 23, 2022
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 16, 2023
Processing time: 75 Days and 0.8 Hours
BACKGROUND
Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.
CASE SUMMARY
A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.
CONCLUSION
Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction. Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.
Core Tip: Spontaneous parathyroid haemorrhage is a rare but potentially life-threatening complication. Anaesthesiologists need to take extra care when administering muscle relaxants to avoid increasing the difficulty of endotracheal intubation. Visual intubation tools, alternative airway devices such as laryngeal masks, and even tracheotomy preparations should be readily available.
