Difficult airway due to cervical haemorrhage caused by spontaneous rupture of a parathyroid adenoma: A case report  

作　　者：Yong-Zheng Han Yang Zhou Ying Peng Jin Zeng Yu-Qing Zhao Xiao-Ru Gao Hong Zeng Xiang-Yang Guo Zheng-Qian Li 

机构地区：[1]Department of Anesthesiology,Peking University Third Hospital,Beijing 100191,China [2]Beijing Center,Quality Control and Improvement on Clinical Anesthesia,Beijing 100191,China [3]Department of General Surgery,Peking University Third Hospital,Beijing 100191,China [4]Department of Otorhinolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing 100191,China [5]Department of Radiology,Peking University Third Hospital,Beijing 100191,China [6]Department of Anesthesiology,Haidian Maternal and Child Health Care Hospital,Beijing 100191,China

出　　处：《World Journal of Clinical Cases》2023年第5期1217-1223,共7页世界临床病例杂志

基　　金：Supported by Key Clinical Projects of Peking University Third Hospital,No. BYSYZD2021013;Beijing Haidian District Innovation and transformation project,No. HDCXZHZB2021202。

摘　　要：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.

关 键 词：Cervical haemorrhage Parathyroid adenoma Muscle relaxants Difficult airway Case report 

分 类 号：R736.2[医药卫生—肿瘤]