Thyroid cartilage fracture

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

Attempted suicide. Found unconscious with electrical wires wrapped around the neck.

Patient Data

Age: 30 years old
Gender: Male
Modality: CT

 

C4/5 and C5/6 facet joint spaces are slightly wider than other levels - this is likely positional secondary to mild reversal of lordosis.

The alignment is otherwise normal.

There is a fracture of the left thyroid cartilage with minimal displacement. Stranding of the subcutaneous fat of the neck mainly on the left is seen.

The patient is intubated. A nasogastric tube is coiled in the pharynx and then descends to at least the level of the carina. A nasopharyngeal airway and separate tube through the oral cavity are in place.

Modality: CT

Carotid systems and vertebral arteries are patent throughout with no evidence of stenosis, dissection or structural abnormality. The intracranial arterial vasculature is normal in appearance. There is preserved grey white matter differentiation and no evidence of brain swelling.

Conclusion:

Thyroid cartilage fracture.

No definite cervical spine fracture or dislocation. Mild symmetric C4/5 and C5/6 widening may be positional rather than due to facet injury- clinical correlation suggested. No evidence of neck vessel dissection.

 

Case Discussion

Laryngeal trauma such as thyroid cartilage fracture is usually the result of blunt trauma, e.g. a punch, or strangulation as in this case. The fracture can be associated with significant oedema and resultant airway compromise. The presumend mechanism of unconsciousness in this patient was hypoxia. As the patient was intubated at the time of CT, airway narrowing/oedema was difficult to assess.

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Case Information

rID: 30026
Case created: 12th Jul 2014
Last edited: 14th Mar 2016
System: Head & Neck
Tag: ngt
Inclusion in quiz mode: Included

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