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A 63-year-old man presented with a sudden enlargement of his neck. During the previous 10 years, his neck had grown progressively larger until he was no longer able to button up his shirts or wear a necktie. A previous diagnosis of cystic hygroma had been made, and conservative management advised. The increase in swelling on the left side of his neck occurred suddenly while he was watching television. He felt faint on swallowing and began pooling saliva. On examination, his neck was swollen, soft, and nontender (Panel A). The swelling moved on swallowing. Computed tomography (Panel B) showed a large thyroid goiter, displacing and compressing both internal carotid arteries and jugular veins. A large hematoma on the left side accounted for the sudden increase in the size of his neck. His airway was not compromised. Laboratory evaluation demonstrated normal thyroid function. He underwent a partial thyroidectomy, with removal of 556 g of thyroid tissue. A multinodular goiter with acute hemorrhage was found, with no evidence of a prior cystic hygroma. He made an uneventful recovery and was doing well more than a year later.
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