Psychogenic respiratory distress — anxiety induced airway collapse

Abstract

Presentation
56-year-old female with sudden onset dyspnoea, stridor and vomiting on day one post elective thyroid biopsy.

Diagnosis
Pschogenic upper airway obstruction and respiratory distress. Severe anxiety in relation to the potential complications following a fine needle thyroid biopsy under local anaesthetic causing compromise of the airway, dyspnoea and stridor. Diagnosis of exclusion following normal nasendoscopy and radiology images.

Treatment
Intubation and mechanical ventilation with corticosteroids for supraglottic swelling.

Discussion
Haematoma formation leading to airway obstruction following a thyroid biopsy is a rare complication that must be disclosed to patients to gain informed consent for the procedure. The clinical presentation of severe anxiety related to the potential of this complication occurring can mimic a mechanical obstruction. It is a diagnosis of exclusion and requires definitive airway management prior to diagnostic assessment.