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• W2894959561 abstract "SESSION TITLE: Critical Care 3 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Stridor in the Intensive Care Unit (ICU) is commonly associated with post-extubation endotracheal edema. We present an unusual case of stridor in the ICU due to a thyroid abscess. CASE PRESENTATION: A 46-year-old woman with history of uncontrolled diabetes and hypertension presents with shortness of breath and difficulty swallowing for 2 weeks. She had a recent diagnosis of pneumonia, for which she was treated with azithromycin and subsequently returned due to lack of improvement. At the time of admission, she was treated empirically with vancomycin and cefepime. 12 hours after admission, she developed worsening dyspnea, and was transferred to the ICU. She was afebrile with a blood pressure of 142/74, a heart rate of 110, and a respiratory rate of 35. Examination showed accessory respiratory muscle use, with inspiratory and expiratory stridor audible only with the stethoscope. ENT performed a flexible laryngoscopy that showed the left vocal cord to be fixed in median position, and the right vocal cord to be hypo-mobile. She was intubated for stridor and respiratory distress. Laboratory workup was significant for leukocytosis (WBC 29.8) and a TSH of 0.02 and Free T4 of 4.40 (0.9-1.76 ng/dL). A CT neck with contrast showed a multi-spatial fluid collection in the left parapharyngeal space tracking and forming a collection in the left thyroid bed measuring 4.8 cm, following which an incision and drainage of the left thyroid abscess and transoral drainage of the left parapharyngeal space abscess was performed. The blood cultures, sputum cultures, and fluid from the parapharyngeal space grew methicillin resistant staphylococcus aureus (MRSA). A repeat CT neck showed clearance of the abscess with mild laryngeal edema, and there was normalization of her white blood cell count and thyroid hormone levels. The patient was eventually extubated and discharged home on oral antibiotics within a week following drainage. DISCUSSION: This is an unusual presentation of stridor in the ICU, without any recent airway manipulation. The majority of cases of vocal cord paralysis are due to thyroidectomy, primary neurological disease, malignancies and diseases in the mediastinum that affect the recurrent laryngeal nerve. Infection is a very rare cause of bilateral vocal cord dysfunction. With primary resolution of the infection, the edema should subside and allow recovery of the airway and vocal cord edema. Thyroid abscesses may arise from hematogenous, lymphatic spread or by direct spread from infections. The most common causative organism implicated in thyroid abscesses is Streptococcus and gram negative bacilli, but S. aureus has also been reported rarely . CONCLUSIONS: In patients with stridor in the setting of sepsis, a parapharyngeal infection or thyroid abscess should be considered. Reference #1: Jeng LB, Lin JD, Chen MF. Acute suppurative thyroiditis: a ten-year review in a Taiwanese hospital. Scand J Infect Dis. 1994;26(3):297-300 Reference #2: Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg. 2004 Dec;62(12):1545-50 Reference #3: Holinger LD, Holinger PC, Holinger PH. Etiology of bilateral abductor vocal cord paralysis: a review of 389 cases. Ann Otol Rhinol Laryngol. 1976 Jul-Aug;85:428-36 DISCLOSURES: No relevant relationships by Sujith Cherian, source=Web Response No relevant relationships by Rosa Estrada-Y-Martin, source=Web Response No relevant relationships by Elshad Hasanov, source=Web Response No relevant relationships by Moiz Salahuddin, source=Web Response" @default.
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• W2894959561 date "2018-10-01" @default.
• W2894959561 modified "2023-10-17" @default.
• W2894959561 title "AN UNUSUAL CASE OF STRIDOR" @default.
• W2894959561 doi "https://doi.org/10.1016/j.chest.2018.08.239" @default.
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