Tracheal Perforation from Primary Thyroid Lymphoma

Abstract

Objective: To describe a rare case of tracheal perforation due to invasive primary thyroid lymphoma and suggest that expectant management with temporary airway protection is an option to invasive interventions such as tracheotomy and tracheal stent placement.

Method: We report a case of primary B-cell thyroid lymphoma causing acute airway obstruction in an elderly female who required emergency endotracheal intubation for airway protection.

Results: After receiving one cycle of chemotherapy with rapid response in terms of tumor size reduction, she was found to have extensive anterior tracheal wall necrosis and perforation on both radiologic imaging and direct bronchoscopic examination. She was able to be quickly extubated and survived without intervention.

Conclusion: There is currently no standard of care in terms of management of invasive thyroid lymphoma causing airway obstruction due to its rare incidence. We propose that expectant management with temporary airway protection is an option to procedures such as tracheotomy or tracheal stenting, even in the scenario of airway perforation.