Contributed by
The Hospital for Sick Children
Danah Omran, and Alejandra Bedoya.
History
13-year-old male with persistent neck pain and dysphagia following blunt neck trauma 3 weeks earlier after being grabbed by his younger sister.
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Question
What is the diagnosis?
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Correct answer
Thyroid cartilage fracture
Discussion
Thyroid cartilage fracture is a rare laryngeal injury and is particularly uncommon in children due to the more elastic laryngeal framework.
Presentation may be subtle or delayed, requiring a high index of suspicion. CT is the imaging modality of choice; however, in children with non-ossified cartilage, ultrasound can be helpful in detecting superficial or deep laryngeal hematoma.
In our case, ultrasound demonstrated irregularity and buckling of the left aspect of the thyroid cartilage, in keeping with a non-displaced fracture. No superficial or internal hematoma identified. In pediatric patients, CT findings of thyroid cartilage fractures may be subtle, particularly due to the lack of ossification of the cartilage. CT of thyroid cartilage fracture may demonstrate focal disruption, irregularity, or displacement of the thyroid cartilage. Associated soft tissue hematoma may also be present.
Early diagnosis is important to prevent airway compromise and long-term complications.
Differential diagnosis
In the appropriate traumatic clinical setting, the findings are most consistent with thyroid cartilage fracture. In the absence of trauma, developmental cartilage irregularity may be considered.
Additional images
References
- 1. Ye X, et al. Rapid detection of thyroid cartilage fracture by ultrasound in a multiple trauma patient. Intensive Care Med. 2014 . 2. Nerurkar N, et al. Thyroid cartilage fracture: an unusual presentation. Arch Otolaryngol Head Neck Surg. 2005