术后颈部血肿 (PNH) 是甲状腺切除术后的一种罕见并发症，仅在 1.1-3.15% 的病例中发生，可导致危及生命的结果。更罕见的是，尚未报道临床表现和体位不典型的延迟性 PNH。在这种情况下，早期识别和立即医疗干预至关重要。作者介绍了一名与气管粘连的甲状腺癌患者，该患者接受了甲状腺切除术后，在胸骨后区域经历了迟发性 PNH，并被呼吸道病原体感染。同时，患者术后出现喉返神经（RLN）麻痹。临床表现中未发现 PNH；尽管这种情况很少见，但 PNH 可导致严重的并发症，尤其是迟发性并发症或非典型体位但不伴有颈部肿胀的并发症。当与 RLN 麻痹同时发生时，血肿可以被忽略。因此，早期诊断和治疗至关重要。临床医生应对非典型PNH保持警惕，因为颈部可能没有肿胀。宫颈超声检查对于诊断至关重要，并且可以进行多次。宫颈 CT 扫描应成为常规检查的一部分，而超声造影可以帮助检测活动性出血。如果肿瘤与气管紧密相连，建议术后早期使用抗生素。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 出版

Postoperative neck hematoma (PNH), a rare complication following thyroidectomy, occurs in only 1.1-3.15% of cases and can lead to life-threatening outcomes. More rarely, delayed PNHs with atypical clinical manifestations and positions have not yet been reported. Early identification and immediate medical intervention are of utmost importance in such cases.The authors represented a patient with thyroid cancer adherent to the trachea, who underwent post-thyroidectomy, experienced delayed PNH in the retrosternal region and was infected by respiratory pathogens. Meanwhile, the patient developed recurrent laryngeal nerve (RLN) paralysis after surgery. PNH was not identified in the clinical manifestations; instead, it was detected only through successive cervical ultrasound examinations.Although rare, PNH can lead to serious complications, especially delayed complications or those in atypical positions, without neck swelling. When simultaneously with RLN paralysis, the hematoma may be neglected. Therefore, early diagnosis and treatment are crucial.Clinicians should be vigilant of atypical PNH because neck swelling may be absent. Cervical ultrasonography is essential for diagnosis and can be performed multiple times. Cervical CT scans should be part of the routine procedure, while contrast-enhanced ultrasound can help detect active bleeding. Early postoperative antibiotics are recommended if the tumor is closely attached to the trachea.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.