Journal List > J Korean Endocr Soc > v.23(3) > 1003436

Kim, Kim, Kim, Jeong, Lee, Choi, Yim, Lee, Kim, Shong, and Kim: A Case of Diffuse Hemorrhage into the Thyroid Gland after Fine Needle Aspiration, and This was Treated by Arterial Embolization


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 enlarged. 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 6th 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.

Figures and Tables

Fig. 1
CT of chest and neck. A. Chest CT revealed calcified nodule in left lower lobe of thyroid. B. Neck CT without contrast-enhancement revealed diffuse enlargement of thyroid gland with heterogeneous hyper-attenuated area suspicious for intra thyroidal hemorrhage. C. Neck CT with enhancement revealed diffusely enhanced thyroid gland with highly enhanced area in left lower lobe of thyroid.
Fig. 2
Neck lateral X-ray. Diffuse swelling was noted at the soft tissue of anterior neck.
Fig. 3
Angiogram of left inferior thyroid artery. No definite bleeding focus was noted. Arrow indicated left inferior thyroid artery.
Fig. 4
Angiogram of left external carotid artery. Left superior thyroid artery was severely congested and partial embolization was done by particle via micro catheter. Arrow indicated left superior thyroid artery.
Fig. 5
99m-Tc Thyroid scan. Decreased uptake of both thyroid lobes and cold nodule in left thyroid lobe lower pole was noted.
Table 1
Diffuse hemorrhage of thyroid caused by fine needle aspiration

N/A: Not available.

* No discrete explanation for type of surgery.


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