Abstract
Although fine needle aspiration (FNA) is an useful and accurate tool in the diagnosis of thyroid nodules with minimal side effect [1, 2], massive intrathyroidal hemorrhage causing acute airway compression is possible and can be fatal. Several cases causing emergent thyroidectomy due to acute airway compression after FNA have been reported [3, 4]. However, it is difficult to determine the necessity of thyroidectomy because intrathyroidal hemorrhage can be resolved via tight compression without thyroidectomy if the airway compression is not serious. Our experience is as follows: A 45-year-old woman visited emergency room due to painful anterior neck swelling and mild dyspnea after diagnostic FNA. After FNA, the patient did not complain of any specific symptoms on the FNA site; however, 3 h later, the patient felt painful swelling, mild dyspnea, and dysphagia in the anterior neck area without subcutaneous hematoma. At that time, there was no abnormal finding in the thyroid function and blood coagulation test. A flexible laryngoscopic examination did not show narrowing of the trachea, although sonography (Fig. 1a) and computed tomography scan revealed diffuse swelling of the bilateral thyroid lobes. Surgery was considered, but no definite active bleeding was observed in CT image. Therefore, the patient was closely observed with tight compression on the swelling site for several hours. Fortunately, the dyspnea and painful swelling were reduced over time. The patient underwent continuous tight compression around the neck using an elastic bandage for one day after manual compression. After 2 days, follow-up thyroid sonography (Fig. 1b) demonstrated findings similar to those before the FNA, with complete resolution of the intrathyroidal hemorrhage. The painful swelling of the neck had subsided, and the comfort level of the patient returned to the level before the FNA procedure. Thyroid nodules have plentiful and aberrant or weakened vessels, and FNA penetration of these vessels can cause bleeding around the aspirated nodule within the thyroid capsule [3–5]. Therefore, clinicians should be aware of the complications of FNA and perform the procedure carefully, and should check for hemorrhage or hematoma after the procedure. Acute intrathyroidal hemorrhage after FNA can lead to severe airway compression, and prompt intervention such as thyroidectomy is needed in the case of rapid progression with continuous active bleeding. At the same time, careful consideration before emergent thyroidectomy should be taken to determine whether spontaneous resolution is possible. In this regard, there are few reports which show completely resolved cases from serous intrathyroidal hemorrhage after FNA. In addition, there are few cases to help determine whether emergent thyroidectomy should be performed. Therefore, we would like to propose careful manual compression at the aspiration site and careful decision-making in performing emergent thyroidectomy according to the presence of airway compression and active bleeding. However, it is necessary to discuss the indication or guideline for decision about conservative management and thyroidectomy in the Y. S. Lee Radiology Department, Chonbuk National University Hospital, Jeonju, South Korea
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.