A Rapidly Expanding Neck Mass with Risk of Airway Compromise; A Case Report

Airway compromise and impending collapse should be considered in all patients presenting with a neck mass. This patient presented to the emergency department (ED) two weeks prior with concerns for rapid growth of a neck mass; after being sent home with an outpatient referral to specialty services, she re-presented when she developed progressive dyspnea and stridor. Imaging was concerning for anaplastic thyroid carcinoma that had grown over two centimeters (cm) in the past 15 days from 10.1 cm to 12.2 cm with new tracheal deviation and adjacent thrombus compression of the internal jugular vein and superior vena cava. Emergency medicine physicians should be cautious when discharging a patient with a neck mass. Outpatient referral should be considered only when the stability of the size of the mass can be reliably confirmed and close outpatient follow-up is guaranteed. Without these stipulations, ED physicians should advocate for admission of these patients so that specialty teams, such as otolaryngology, interventional radiology, and hematology/oncology, can begin management before airway compromise poses a significant threat to the life of the patient.