Objectives: To report on a patient who underwent a total thyroidectomy and re-presented three weeks later with significant subcutaneous emphysema due to a tracheal perforation.
Case report: A 42 year old man underwent a thyroidectomy to remove a papillary carcinoma. He re-presented three weeks later with a fluctuant anterior neck swelling which was reducible and increased in size on raised intra-thoracic pressure. A lateral neck x-ray showed a large pocket of air and a subsequent CT scan showed a small defect in the anterior tracheal wall. This was visualised with a rigid bronchoscopy and found to be a pin-sized perforation. The patient was managed conservatively and the swelling resolved over a period of 2 to 3 weeks.
Conclusions: Delayed post thyroidectomy tracheal perforation is a very rare complication. In this case the patient had no respiratory compromise and so conservative management was seen to be the best management option.