Pseudoaneurysm of the inferior thyroid artery presenting as a thyroid nodule

Massive hemorrhage arising of inferior thyroid artery by radiofrequency ablation for secondary hyperparathyroidism: Two case reports

PATIENT CONCERNS AND DIAGNOSIS

Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease. Radiofrequency ablation (RFA) is a safe and minimally invasive treatment for SHPT, which can effectively reduce the level of parathyroid hormone (PTH). Inferior thyroid artery (ITA) is a rare and dangerous complication, We report two cases of ITA bleeding caused by RFA. Intraoperative contrast-enhanced ultrasound (CEUS) can accurately show the source and scope of bleeding. Ultrasound guided RFA and compression hemostasis were successful.

INTERVENTIONS

During the operation, CEUS was used to detect ITA bleeding, bleeding range and location quickly and accurately at the early stage, and ultrasound guided compression and RFA were used to treat small bleeding points. ITA bleeding was timely and effectively controlled, and the bleeding range was limited to pseudoaneurysm.

OUTCOMES

The patient received antiplatelet and anticoagulant therapy for 2 days, and the pseudoaneurysm was filled with thrombus 36 hours and 72 hours after surgery. Later, the ultrasonography examination showed that the hematoma was gradually absorbed and contracted.

CONCLUSION

Although RFA is a safe and minimally invasive treatment for secondary hyperparathyroidism, rupture and bleeding of the ITA are rare and dangerous. CEUS can quickly and accurately judge bleeding, bleeding range and location in the early stage. Ultrasound guided compression and RFA of small ITA bleeding points can timely and effectively control bleeding, limit the bleeding range to pseudoaneurysms, and close themselves.

Endovascular treatment of massive hemorrhage arising from inferior thyroid artery after fine needle aspiration of thyroid: a case report

BACKGROUND

Fine needle aspiration (FNA) of the thyroid gland is an effective and safe method for evaluating thyroid nodules; catastrophic complications following FNA of thyroid are rare. Massive hematomas with active bleeding leading to airway compromise are extremely rare complications of FNA, with only a few reported cases in literature.

CASE PRESENTATION

An 80 year-old man presented to the emergency room with severe respiratory distress, four hours after undergoing thyroid FNA for the evaluation of a thyroid nodule. An axial neck computed tomography (CT) revealed a large hematoma in the retropharyngeal space that caused anterior deviation of the trachea, with extravasation of contrast media suggesting active bleeding within the hematoma. Right subclavian angiography identified active bleeding from the right inferior thyroid artery (ITA). Transcatheter arterial embolization (TAE) was successfully performed with n-Butyl cyanoacrylate (NBCA). Follow-up CT done three weeks after the procedure revealed a low-density lesion in the retropharyngeal space, indicating an old hematoma. The patient recovered well and was discharged 6 weeks later.

CONCLUSION

Massive hemorrhage arising from the ITA is a rare but possible complication following FNA, which can potentially be fatal. Appropriate preventive measures should be taken while performing FNA, especially in patients on long-term anticoagulant drugs, and prompt intervention is mandatory for patients with acute hematoma after FNA.

Coil embolization in ruptured inferior thyroid artery aneurysm with active bleeding

We present a unique experience of urgent parent arterial embolization for treatment of an aneurysm of the inferior thyroid artery (ITA) that bled during tracheostomy. The event happened to a 69-year-old female patient with subarachnoid hemorrhage and hospital-acquired pneumonia that required tracheostomy. Abrupt and massive bleeding developed during the procedure, and the source could not be identified. Under manual compression, angiography revealed an 8-mm aneurysm that arose from the inferior thyroid artery. The superselected parent artery of the aneurysm was successfully occluded with a single pushable coil. The patient's postoperative course was uneventful.

Pitfalls in sonographic evaluation of thyroid abnormalities

Ultrasound of the thyroid has become increasingly common, with evaluation of thyroid nodules representing the main indication for its use. While detection of thyroid nodules with modern high-resolution sonographic equipment is generally not a challenge, pitfalls may occur by which normal structures or pathology in neighboring organs are mistaken for thyroid nodules. Numerous reports in the literature describe various sonographic features of nodules in an attempt to stratify lesions into benign or malignant categories. While neither nodule size nor number is reliable, echogenicity, microcalcifcation, shape, and composition have been reported to be helpful in classifying thyroid nodules. No single feature should be used in isolation, and consensus guidelines have been established as to when fine-needle aspiration is indicated. Pitfalls remain in the evaluation of thyroid nodules demonstrating atypical features, such as cystic papillary carcinomas. Focal presentation of typically diffuse processes, such as Graves' disease and Hashimoto thyroiditis, may mimic malignant nodules, but carcinomas occur in these settings as well as in a background of normal thyroid parenchyma. Finally, because ultrasound is commonly used for surveillance of patients with thyroid carcinoma after thyroidectomy, sonographers should be familiar with the ultrasound appearance of disease recurrence and its mimics.

Computed tomography diagnosis of active bleeding into the thyroid gland

BACKGROUND

Fine-needle biopsy of the thyroid gland is the most common interventional procedure used to diagnose thyroid diseases. Serious complications are rare in this procedure. They comprise an infection with abscess formation and hemorrhage. To date, only a few case reports have described an ultrasound diagnosis of active bleeding into the thyroid gland. We established such a diagnosis using computed tomography (CT).

PATIENT FINDINGS

A 74-year-old woman presented to the emergency department of our hospital with complications after fine-needle biopsy of the thyroid gland. Ultrasound revealed a large hematoma surrounding the gland. A subsequent CT scan confirmed the presence of hematoma and, moreover, showed active bleeding. This finding prompted rapid surgical intervention.

CONCLUSION

CT has the capability to show active bleeding into the thyroid gland.

Inferior thyroid artery pseudoaneurysm caused by blunt trauma

Injury to the inferior thyroid artery (ITA) is an extremely rare complication of blunt neck trauma. The subtle initial clinical presentation and the potential life-threatening sequelae make it a diagnostic and therapeutic challenge. We report a case of an ITA pseudoaneurysm caused by seat-belt injury. Imaging findings and successful treatment with coil embolization are described. The role of noninvasive imaging techniques in establishing the diagnosis is emphasized.