A 53-Year-Old Woman Is Evaluated in the Postanesthesia Care Unit

A 53-year-old woman is evaluated in the postanesthesia care unit following thyroid surgery.  She underwent a total thyroidectomy for a retrosternal goiter that was causing dysphagia from esophageal compression.  The patient states her neck feels a little "tight" but has no significant pain or difficulty breathing.  Medical history is otherwise unremarkable.  Temperature is 37 C (98.6 F) , blood pressure is 126/86 mm Hg, and pulse is 100/min.  Oxygen saturation is 99% on room air.  On physical examination, the patient appears comfortable, with no distress.  Pupils are equal, round, and reactive.  Voice is normal.  Neck incision is well-approximated, and there is a 4-cm ballotable swelling under the incision.  The lungs are clear to auscultation.  Heart sounds are normal.  The neck swelling increases in size during the examination.  Which of the following is the best next step in management?

A) Compressive dressing application
B) CT scan of the neck with contrast
C) Fluoroscopic swallowing study
D) Immediate wound exploration
E) Urgent cricothyrotomy

Correct Answer:

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