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Acute Mediastinitis due to Spontaneous Rupture of a Thyroid Cyst
Mediastinitis aguda por rotura espontánea de quiste tiroideo
Irene Garrido Márquez
, Patricia Virginia García Pérez, José Luis Martín Rodríguez
Corresponding author
Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Cecilio, Granada, Spain
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array:24 [ "pii" => "S0300289621004142" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.04.031" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2970" "copyright" => "SEPAR" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2022;58:T255" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289621001563" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.04.028" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2836" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2022;58:257" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen Clínica</span>" "titulo" => "Calcificaciones pulmonares como secuela de neumonía COVID-19" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "257" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pulmonary Calcifications as COVID-19 Pneumonia Sequelae" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 916 "Ancho" => 1300 "Tamanyo" => 108291 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las imágenes de la izquierda corresponden con cortes en ventana de pulmón de la tomografía computarizada realizada en el ingreso, en la que se ven múltiples focos consolidativos parcheados en relación con neumonía por COVID-19. A la derecha, se observan cortes en ventana de hueso con calcificaciones pulmonares que coinciden con las opacidades previas. La variabilidad entre los cortes se debe a que la tomografía del ingreso fue de cortes de 2,5 mm y la de control de 1 mm.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Virginia Gallo González, Daniel López-Padilla, Luis Puente Maestú" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Virginia" "apellidos" => "Gallo González" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "López-Padilla" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Puente Maestú" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621001563?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000003/v2_202210210711/S0300289621001563/v2_202210210711/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289621001459" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.04.024" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2829" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2022;58:255" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen Clínica</span>" "titulo" => "Mediastinitis aguda por rotura espontánea de quiste tiroideo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "255" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acute Mediastinitis due to Spontaneous Rupture of a Thyroid Cyst" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 486 "Ancho" => 641 "Tamanyo" => 55128 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Ecografía de cuello en modo B, donde se observa la glándula tiroides (flecha hueca) con una lesión quística con tabiques y ecos móviles en su interior dependiente de su lóbulo izquierdo (flecha fina). B y C) TC cérvico-torácica con contraste intravenoso en planos coronal (B) y axial (C). Se observa una formación de densidad quística que parece depender del polo inferior del lóbulo tiroideo izquierdo, con extensión intratorácica (flecha fina), y que condiciona desplazamiento hacia la derecha de la tráquea (asteriscos) y esófago, con engrosamiento parietal del mismo. En el margen más caudal de la lesión quística se observa discontinuidad de su pared (cabeza de flecha), en probable relación con rotura. Asocia aumento de densidad de la grasa mediastínica superior, así como adenopatías (flecha hueca), sugerentes de cambios inflamatorios mediastínicos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Irene Garrido Márquez, Patricia Virginia García Pérez, José Luis Martín Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Irene" "apellidos" => "Garrido Márquez" ] 1 => array:2 [ "nombre" => "Patricia Virginia" "apellidos" => "García Pérez" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "Martín Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621001459?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000003/v2_202210210711/S0300289621001459/v2_202210210711/es/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0300289621001459" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.04.024" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2829" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2022;58:255" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen Clínica</span>" "titulo" => "Mediastinitis aguda por rotura espontánea de quiste tiroideo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "255" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acute Mediastinitis due to Spontaneous Rupture of a Thyroid Cyst" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 486 "Ancho" => 641 "Tamanyo" => 55128 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Ecografía de cuello en modo B, donde se observa la glándula tiroides (flecha hueca) con una lesión quística con tabiques y ecos móviles en su interior dependiente de su lóbulo izquierdo (flecha fina). B y C) TC cérvico-torácica con contraste intravenoso en planos coronal (B) y axial (C). Se observa una formación de densidad quística que parece depender del polo inferior del lóbulo tiroideo izquierdo, con extensión intratorácica (flecha fina), y que condiciona desplazamiento hacia la derecha de la tráquea (asteriscos) y esófago, con engrosamiento parietal del mismo. En el margen más caudal de la lesión quística se observa discontinuidad de su pared (cabeza de flecha), en probable relación con rotura. Asocia aumento de densidad de la grasa mediastínica superior, así como adenopatías (flecha hueca), sugerentes de cambios inflamatorios mediastínicos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Irene Garrido Márquez, Patricia Virginia García Pérez, José Luis Martín Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Irene" "apellidos" => "Garrido Márquez" ] 1 => array:2 [ "nombre" => "Patricia Virginia" "apellidos" => "García Pérez" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "Martín Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621001459?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000003/v2_202210210711/S0300289621001459/v2_202210210711/es/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => " Acute Mediastinitis due to Spontaneous Rupture of a Thyroid Cyst" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "T255" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Irene Garrido Márquez, Patricia Virginia García Pérez, José Luis Martín Rodríguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Irene" "apellidos" => "Garrido Márquez" "email" => array:1 [ 0 => "igamar26@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Patricia Virginia" "apellidos" => "García Pérez" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "Martín Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Cecilio, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mediastinitis aguda por rotura espontánea de quiste tiroideo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 486 "Ancho" => 641 "Tamanyo" => 55128 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) B-mode neck ultrasound showing the thyroid gland (empty arrow) with a cystic lesion containing septations and mobile echoes on the left lobe (thin arrow). (B and C) Cervico-thoracic CT with intravenous contrast in coronal (B) and axial (C) planes. A formation of cystic density is seen on the lower pole of the left thyroid lobe, with intrathoracic extension (fine arrow), causing the trachea (asterisks) and esophagus to shift to the right, with parietal thickening of the trachea (asterisks). Disruption of the wall is observed at the caudal-most margin of the cystic lesion (arrowhead), probably associated with the rupture. Increased density of upper mediastinal fat, and lymphadenopathies (empty arrow), suggestive of mediastinal inflammatory changes are also seen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 63-year-old patient with a history of upper gastrointestinal bleeding due to NSAIDs presented with a few days’ history of cough and dyspnea, with no fever. He reported pain on cervical palpation, and acute phase reactants were significantly elevated.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Computed tomography (CT) angiogram was requested for the assessment of pulmonary arteries due to suspected pulmonary thromboembolism, but only mediastinal inflammatory changes were observed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study was completed with ultrasound and contrast-enhanced cervical CT, revealing a cystic formation with intrathoracic extension on the left thyroid lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), with mobile internal echoes and septations, irregular hyperdense walls on CT, and disruption of the caudal-most gradient (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Increased density of upper mediastinal fat and reactive lymphadenopathies were also observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). These findings suggested complicated thyroid cyst with rupture and signs of secondary mediastinitis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Urgent surgery was performed with cervicotomy, debridement, and left hemithyroidectomy, and piperacillin–tazobactam and linezolid were started. The pathology report confirmed the presence of a complicated thyroid cyst rupture with necrotic remains and acute inflammatory infiltrate.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our case illustrates a cause of acute mediastinitis not described to date: spontaneous rupture of a thyroid cyst. Although cases resulting from as a complication of ablation or thyroid biopsy have been published,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> mediastinitis due to spontaneous rupture without prior manipulation has not been previously reported.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This research study has not received any specific financial support from public, private, or non-profit institutions.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 486 "Ancho" => 641 "Tamanyo" => 55128 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) B-mode neck ultrasound showing the thyroid gland (empty arrow) with a cystic lesion containing septations and mobile echoes on the left lobe (thin arrow). (B and C) Cervico-thoracic CT with intravenous contrast in coronal (B) and axial (C) planes. A formation of cystic density is seen on the lower pole of the left thyroid lobe, with intrathoracic extension (fine arrow), causing the trachea (asterisks) and esophagus to shift to the right, with parietal thickening of the trachea (asterisks). Disruption of the wall is observed at the caudal-most margin of the cystic lesion (arrowhead), probably associated with the rupture. Increased density of upper mediastinal fat, and lymphadenopathies (empty arrow), suggestive of mediastinal inflammatory changes are also seen.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous rupture of hemorrhagic thyroid nodules causing extensive laryngopharyngeal, neck, and chest hematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.L.W. Wong" 1 => "R. Jaafar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Egypt J Otolaryngol" "fecha" => "2017" "volumen" => "33" "paginaInicial" => "128" "paginaFinal" => "130" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rupture of benign thyroid tumors after radio-frequency ablation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.H. Shin" 1 => "S.L. Jung" 2 => "J.H. Baek" 3 => "J.H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3174/ajnr.A2661" "Revista" => array:6 [ "tituloSerie" => "Am J Neuroradiol" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "2165" "paginaFinal" => "2169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21920870" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000003/v2_202210210711/S0300289621004142/v2_202210210711/en/main.assets" "Apartado" => array:4 [ "identificador" => "93646" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Images/Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000003/v2_202210210711/S0300289621004142/v2_202210210711/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621004142?idApp=UINPBA00003Z" ]
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