September 2014 Case of the Month- Courtesy of Andrew Oh

A 46yo male presented with anterior neck swelling and erythema that rapidly progressed over the past day.  He had a history of thyroid nodules.  He also reported mild vocal changes and dysphagia.  He had no other complaints.   On exam he had right anterior neck erythema, induration and a palpable tender mass.  Ultrasound was used to further evaluate the mass-

Cystic nodules within the thyroid are often benign adenomatous nodules, with degeneration or hemorrhage.  Other types include benign follicular adenomas or malignancy, such as papillary thyroid carcinomas, which often have accompanying cystic degeneration.  FNA bedside for our patient revealed brown, murky fluid of which 5-6 cc was aspirated.  Pathology revealed a hemorrhagic cyst.  His symptoms markedly improved after aspiration- which is often not the case if the nodules are more complex.