A Case of Diffuse Hemorrhage into the Thyroid Gland after Fine Needle Aspiration, and This was Treated by Arterial Embolization

Abstract

Although hematoma formation after fine needle aspiration cytology fine needle aspiration cytology (FNAC) is a most common complication and most of these hematomas are self-limiting with minimal pain, a massive intra-thyroidal hemorrhage that produces acute airway obstruction had rarely been reported on. A 60-year old female underwent ultrasound-guided FNAC for evaluation of nodules that were in the right lobe (0.5 cm) and left lobe (3 cm) of her thyroid gland. Two hours later, the patient experienced swelling and progressive pain in the anterior neck. She visited an emergency room with dyspnea at 6 hours after FNAC. On the initial examination, her vital signs were stable and the oxygen saturation was 100%. On physical examination, her thyroid gland was tender and diffusely enlarge d. Neck CT revealed diffuse enlargement of the thyroid gland with heterogeneous hyper-attenuated areas that were suspicious for intra-thyroidal hemorrhage and a highly enhanced area in the left lower lobe of the thyroid. No definite bleeding focus was identified on the angiography that was done through the carotid artery, but the left superior thyroid artery was severely congested and partial embolization was done. After embolization her neck pain and tenderness decreased over several days and the patient was discharged on the 6 th hospital day. We report here on a case of diffuse hemorrhage into the thyroid gland after FNAC, and this was successfully treated with arterial embolization.