Session: SAT 449-497-Thyroid Neoplasia & Case Reports
Poster Board SAT-450
Clinical case: After total thyroidectomy and right modified radical neck dissection two years ago due to papillary thyroid cancer with right cervical lymph node metastasis (T3N1M0), a 73-year-old female complained of dyspnea and orthopnea She was not able to have a deep sleep because of shortness of breath which was aggravated in supine position. Obstructive lung disease was excluded because her pulmonary function test, gastroscopy, echocardiography, coronary computed tomographic angiography revealed no additional findings. Interestingly, however, her chest x-ray findings at two weeks after operation revealed an elevated ipsilateral hemidiaphragm when compared with pre-operative images, and still remained elevated even one year after the surgery. The fluoroscopic “sniff” test during which diaphragmatic movement is observed fluoroscopically while the patient sniffs forcefully, showed the paradoxical elevation of the paralyzed hemodiaphragm with inspiration and the rapid descent of the normal hemidiaphragm. She received conservative management with medications such as mucolytics, theophylline, anti-tussive agents. Six months after the diagnosis, her symptoms improved, but the elevation of hemi-diaphragm at the chest X-ray is observed.
Conclusion: In case of the abrupt dyspnea after thyroid surgery, the possibility of diaphragmatic paralysis should be considered. Early diagnosis and active treatment will be able to reduce the duration of illness and improve related symptoms.
Nothing to Disclose: SKK, JKH, SYP, JIS, SOC, SYR, SC, YCH, IKJ, SO, KJA, HYC, JTW, SWK, YSK
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