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Cough syncope and tracheal compression secondary to a retrosternal goitre: looking for a pulmonary embolism
  1. Waqas Bin Majid Din1,
  2. Eleanor Farrar1,
  3. Cindy Liu2 and
  4. James Moor1
  1. 1 ENT, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2 Plastic Surgery Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Waqas Bin Majid Din, wbmdin{at}


A 51-year-old man presented acutely with recurrent bouts of coughing associated with transient and brief loss of consciousness consistent with cough syncope, mild stridor and a recent history of a respiratory tract infection. A chest X-ray demonstrated tracheal narrowing. His D-dimer was negative. A non-contrast CT scan of the chest demonstrated a large retrosternal goitre causing tracheal compression, and further investigation with a contrast-enhanced CT scan of the neck and chest demonstrated an incidental finding of a large pulmonary embolus (PE). The full extent of the PE was determined through performing a CT pulmonary angiography. Doppler ultrasound demonstrated a left leg deep vein thrombosis as the primary cause of the PE. His cough syncope improved in response to anticoagulation treatment, to the point where he could be safely discharged home. He had a further significant improvement in symptoms following an elective hemithyroidectomy for retrosternal goitre.

  • venous thromboembolism
  • ear, nose and throat
  • respiratory system

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  • Contributors WBMD, the principal author, wrote initial background, case presentation and follow-up, and helped with finalising the paper edit and referencing, along with liaising with the patient to obtain consent. EF primarily helped with differential diagnosis, research on the patient, investigations and treatment, and helped with the principal write-up of these sections. CL helped with writing the background, summary and initial draft, along with image editing, and editing and writing part of the discussion. JM, the principal consultant who managed the patient and came up with the concept, helped with the write-up of the management plan, editing, and referencing the background and learning agreements.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.