Presentation
Anterior neck swelling.
Patient Data
Right thyroid lobe expanding cystic lesion with fluid-fluid level showing echogenic lower part. It measures 4.6 cm in diameter and pushes the rest of the right lobe upwards. It exerts a mass effect in the form of moderate tracheal deviation towards the left side. It shows fluid tracking around the right thyroid lobe, suggestive of a hemorrhagic thyroid cyst with rupture.
A few benign-looking complex/cystic thyroid nodules with iso to hypoechoic solid part (TR2) are noted.
Deviation of tracheal air column to the left side at the level of thoracic inlet.
Case Discussion
Ultrasound features represent a hemorrhagic thyroid cyst with rupture and tracheal shift towards the left side. The patient reported a past incident of hemorrhagic thyroid cyst managed by US-guided aspiration.
Spontaneous intranodular hemorrhage of the thyroid gland is rare and mostly develops due to spontaneous hemorrhage in partially cystic thyroid nodules, leading to local mass effect upon the trachea and esophagus.
Urgent intervention and surgery may be required to secure the airway according to the severity of symptoms at presentation.
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