Bilateral Thyroid Ima Arteries Arising From the Brachiocephalic Trunk: A First Case Report.

Rationale: Bilateral thyroid ima artery (TIA) arising from the brachiocephalic trunk is an extremely rare anatomical variation, with no prior cases reported. Recognizing such vascular anomalies is crucial for optimizing surgical outcomes in thyroid and mediastinal procedures, as failure to identify these variations can lead to severe intraoperative complications.

Patient concerns: A 28-year-old female presented for surgical management of a thyroid nodule detected during a routine physical examination. The patient reported no significant medical history or prior neck surgeries. Preoperative ultrasonography revealed a high malignancy risk and evidence of cervical and mediastinal lymph node involvement.

Diagnoses: Intraoperative findings unexpectedly identified two small arteries originating from the brachiocephalic trunk. These were later confirmed as bilateral TIAs through postoperative imaging and 3D reconstruction.

Interventions: The patient underwent total thyroidectomy, bilateral modified radical neck dissection, and mediastinal lymph node dissection. Appropriate measures were taken to preserve these vessels during the procedures.

Outcomes: The patient recovered uneventfully, with no complications. Postoperative imaging validated the intraoperative findings, confirming the unique vascular variation.

Lessons: This case highlights the importance of detailed intraoperative assessment and advanced imaging techniques in surgical planning. Awareness of rare vascular anomalies, such as bilateral TIA, is vital for minimizing surgical risks and improving patient outcomes. This report provides valuable insights into vascular anatomy and clinical practice.