Case report

Rheumatoid nodule of the thyrohyoid membrane: a case report

Tahwinder Upile^1,2,3,4 , Waseem Jerjes^4,5,6 , Fabian Sipaul³ , Sandeep Singh³ , Colin Hopper^4,5,6 , Anthony Wright³ and Ann Sandison⁷

¹  The Ear Institute, University College London, UK

²  Department of Head & Neck Surgery, Charing Cross Hospital, UK

³  Department of Head & Neck Surgery, The Professorial Unit, The Royal National Throat, Nose and Ear Hospital, UK

⁴  Oral & Maxillofacial Surgery/Head & Neck Unit, University College London Hospital, UK

⁵  Department of Surgery, Royal Free & University College Medical School, UK

⁶  Unit of Oral & Maxillofacial Surgery, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, UCL Eastman Dental Institute, UK

⁷  Department of Pathology, Charring Cross Hospital, UK

author email corresponding author email

Journal of Medical Case Reports 2007, 1:123doi:10.1186/1752-1947-1-123

Published:	31 October 2007

Abstract

Background

Rheumatoid nodules are common extra-articular findings occurring in 20% of rheumatoid arthritis patients. They develop most commonly subcutaneously in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and in other connective tissues elsewhere in the body

Case presentation

We present the case of a 62-year-old male who presented with a midline neck mass. Clinically it moved on swallowing and tongue protrusion-suggesting attachment to the thyrohyoid membrane. Ultrasound examination revealed a cystic lesion in the absence of cervical lymphadenopathy in a non-smoker. The neck was explored and histological examination of the excised lesion which was attached to the thyrohyoid membrane revealed a rheumatoid nodule.

Conclusion

A rheumatoid nodule of the thyrohyoid membrane is very rare. The triple diagnostic scheme of clinical examination supplemented with ultrasound and guided fine needle aspiration for neck lumps remains valid in most cases. If excision is indicated we feel it should be performed in such a manner that the scar tract could easily be encompassed in a neck dissection excision should definitive histological examination be adverse. We suggest that when dealing with patients with established rheumatoid arthritis one should consider a rheumatoid nodule as a differential diagnosis for any swelling on the patient whether it be subcutaneous or deep.