Arterial Bleeding of a Thyroid Mass After Thyroid Fine-Needle Aspiration Biopsy: A Case Report

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

“…Several reported cases have described the formation of a retropharyngeal hematoma large enough to become life-threatening. These developed over a few hours with the patient initially presenting with hoarseness and mild dysphasia and rapidly progressed to severe respiratory distress [ 4 – 6 ]. The differential can be complex in these patients, since the symptoms overlap with those of allergic reactions, stroke, or an infectious etiology [ 1 ].…”

“…Arterial injuries during FNA are usually caused by inserting the FNA needle in the upper and anterior part of the gland. As a result, cases concerning STA injury during FNA of thyroid have been reported more than that of ITA [ 4 , 8 ]. Conversely, ITA injury is more common during catheterization via the right internal jugular vein, considering that the proximal portion of ITA has an ascending course just lateral to the internal jugular vein [ 8 , 9 ].…”

“…Third, an arterial puncture resulting in a periarterial hematoma is usually self-limiting with the application of pressure. However, if the arterial injury is severe or if there are pre-existing coagulation abnormalities, continuous arterial bleeding can occur [ 4 ]. The INR was slightly prolonged in this patient prior to the FNA; the patient was on long-term anticoagulant drugs for cardiovascular disease.…”

“…Fine needle aspiration (FNA) of thyroid lesions is a common technique widely used for the diagnostic workup of thyroid nodules [ 1 – 4 ]. It has proven to be a safe, reliable, and effective tool over the years.…”

Thyroid nodule and thyroid cancer management pre- and post-cardiac transplantation

“…19 Although thyroid FNA was not listed, given the location, ease of site compressibility, and limited extent of the procedure, this review and other reports imply that anti-coagulants do not need to be stopped. 18,20,21 The American College of Chest Physicians guidelines also suggest that minor procedures do not require discontinuation of warfarin or aspirin, although it is not clear regarding clopidogrel. 22,23 Conversely, there are recommendations that patients with low thromboembolic risk may stop the warfarin dose for several days without bridging anti-coagulation.…”