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

Abstract 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.

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MASSIVE HEMORRHAGE AFTER ENDOSCOPIC ULTRASOUND GUIDED FINE NEEDLE ASPIRATION OF A CEPHALOPANCREATIC CYSTIC LESION

10.1055/s-0040-1704793 ◽

2020 ◽

Author(s):

P Costa-Moreira ◽

P Moutinho-Ribeiro ◽

G Macedo

Keyword(s):

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Cystic Lesion ◽

Needle Aspiration ◽

Massive Hemorrhage ◽

Ultrasound Guided ◽

Fine Needle

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Comparison on the Use of Spinal (Stylet) Needle and Simple Needle in Ultrasound Guided Thyroid Nodule FNA; Does the Needle Affect Thyroid FNA Result?

Iranian Journal of Radiology ◽

10.5812/iranjradiol.98754 ◽

2020 ◽

Vol 17 (2) ◽

Author(s):

Alireza Aziz Ahari ◽

Mohammad Ali Mohammadi Vajari ◽

Navid Khatibi Moghadam ◽

Hassan Hashemi ◽

Mahmoud Parvin ◽

...

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Significant Relationship ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Fine Needle ◽

Needle Type ◽

Expert Radiologist ◽

Diagnostic Samples ◽

Thyroid Fna

Background: Thyroid fine needle aspiration (FNA) is currently the most acceptable method for evaluating thyroid nodules. Non-satisfactory sample is the main limitation of FNA. It has been shown that spinal needles can reduce the number of non-diagnostic samples. Objectives: In this study, we decided to compare the results obtained using spinal (stylet) needle and simple needle in thyroid nodule FNA according to the agreement between them and with the pathology results as the gold standard. Patients and Methods: Sampling of thyroid nodules of 156 patients was performed by a simple non-stylet 23 gauge needle (A) and a spinal 22 gauge needle with stylet (B). The samples were provided to the pathologist for blind examination. All samples were obtained by an expert radiologist and the pathology examination was also performed by a pathologist expert in thyroid gland diseases. Blind analysis was done using SPSS Statistics for Windows, version 16 (SPSS Inc., Chicago, Ill., USA). Results: The results of FNA with needles A and B were reported unsatisfactory in 11.51 (18 subjects) and 3.84 (six subjects), respectively (P = 0.01). The result in 63.46% (99 subjects) of the participants, in whom FNA was obtained by needle B was introduced as a better sample by the pathologist in comparison with 36.44% (57 subjects) (P < 0.001). Cancer was diagnosed in 9.56 and 7.66 of the samples yielded by needles B and A, respectively, which was not statistically significant (P = 0.54). There was also a significant relationship between thyroid imaging reporting and data system (TI-RADS) score and FNA result. Conclusion: A significant relationship between the adequate sampling results, the qualitative examination result, TI-RADS score and the needle type indicates the importance of needle type on the results of thyroid FNA. Using spinal (stylet) needles may reduce the number of non-diagnostic samples in fine needle aspiration of thyroid nodules and therefore, can have a better effect on the results of this method.

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The Role of Molecular Testing for the Indeterminate Thyroid FNA

Genes ◽

10.3390/genes10100736 ◽

2019 ◽

Vol 10 (10) ◽

pp. 736 ◽

Cited By ~ 5

Author(s):

Esther Diana Rossi ◽

Liron Pantanowitz ◽

William C. Faquin

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Adult Population ◽

Needle Aspiration ◽

Molecular Testing ◽

American Thyroid Association ◽

Cytological Diagnosis ◽

Fine Needle ◽

Thyroid Fna

Thyroid nodules are common in the adult population where a majority are benign and only 4.0% to 6.5% are malignant. Fine needle aspiration (FNA) is a key method used in the early stages to evaluate and triage patients with thyroid nodules. While a definitive cytological diagnosis is provided in more than 70–75% of all thyroid FNA cases, the group of indeterminate lesions offers a challenge in terms of interpretation and clinical management. Molecular testing platforms have been developed, are recognized as an option by the 2015 American Thyroid Association Guidelines, and are frequently used in conjunction with FNA as an integral part of the cytologic evaluation. In this review, the utility of molecular testing options for nodules assigned to the group of indeterminate thyroid FNAs is described.

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MON-479 Acute Thyroid Edema: A Rare Complication of Thyroid Fine Needle Aspiration

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1606 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Rachael Bree Hosein ◽

Neel L Shah ◽

Marc Cillo

Keyword(s):

Thyroid Gland ◽

Neck Pain ◽

Fine Needle Aspiration ◽

Rare Complication ◽

Needle Aspiration ◽

Fine Needle ◽

Thyroid Fine Needle Aspiration ◽

Thyroid Swelling ◽

Thyroid Fna ◽

Thyroid Parenchyma

Abstract Background: Acute thyroid swelling is a rare complication of thyroid fine needle aspiration (FNA). The first documented case was in 1982 and to date there are less than 20 cases currently reported in the literature (1). Case Presentation: A 66-year-old female with a history of non-ischemic cardiomyopathy and heart failure was admitted to hospital to expedite heart transplant evaluation. A neck ultrasound was performed due to voice hoarseness and concern for vocal cord nodules. The ultrasound showed a 1.3 cm hypoechoic nodule in the right thyroid lobe. Given that the nodule had irregular borders and microcalcifications, a thyroid FNA was recommended. The patient’s home warfarin had been held for at least three days prior to the biopsy and her INR on the procedure date was 1.4. Her heparin drip was held four hours prior to the thyroid FNA. Immediately following the procedure, a 3.2 cm hematoma formed inferior to the thyroid gland. The heparin drip was restarted 6 hours post-FNA as per radiology’s recommendation. Cytology of the nodule was benign. The patient recovered well post FNA and improvement in the hematoma was noted on exam. Her hemoglobin was stable and she was restarted on warfarin. On day two post thyroid FNA, she reported significant neck pain, with no corresponding increase in the extra-thyroidal hematoma. No stridor or other concerning features were present on exam. A repeat thyroid ultrasound was performed three days after the FNA. It demonstrated fluid filled ‘cracks’ within the thyroid parenchyma and tripling in the volume of the thyroid gland, concerning for diffuse edema. No heterogeneity or subcapsular thickening was seen to suggest hemorrhage, and the previously demonstrated 3.2 cm extra-thyroidal hematoma was not visualized. She was treated with ibuprofen 800 mg and prednisone 30 mg, and noted an improvement in her neck pain with these measures. A repeat ultrasound done three weeks after initial thyroid FNA showed marked improvement of the diffuse swelling. Conclusion: The phenomenon of diffuse thyroid edema after fine need aspiration has been termed acute thyroid swelling (ATS). Given how frequently thyroid fine needle aspirations are performed, ATS appears to be a very rare complication. The etiology of ATS remains unknown, but the use of blood thinners, such as in our patient, does not appear to be a risk factor (1). The radiological appearance of fluid filled ‘cracks’ within the thyroid parenchyma suggests a more diffuse process, rather than a localized reaction. While NSAIDs or steroids may help with symptoms, patients appear to improve irrespective of whether or not medications are given. This suggests that ATS is a self-limiting condition without long term complications. Reference: (1) Polyzos SA, Anastasilakis AD, Arsos. Acute transient thyroid swelling following needle biopsy: An update. Hormones. 2012;11(2);147-150

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The Use of Fine-Needle Aspiration (FNA) Cytology in Patients with Thyroid Nodules in Asia: A Brief Overview of Studies from the Working Group of Asian Thyroid FNA Cytology

Journal of Pathology and Translational Medicine ◽

10.4132/jptm.2017.10.19 ◽

2017 ◽

Vol 51 (6) ◽

pp. 571-578 ◽

Cited By ~ 7

Author(s):

Chan Kwon Jung ◽

SoonWon Hong ◽

Andrey Bychkov ◽

Kennichi Kakudo

Keyword(s):

Fine Needle Aspiration ◽

Working Group ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Fine Needle ◽

Thyroid Fna

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Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2015-0154-sa ◽

2016 ◽

Vol 140 (10) ◽

pp. 1121-1131 ◽

Cited By ~ 33

Author(s):

Elliot A. Krauss ◽

Megan Mahon ◽

Jean M. Fede ◽

Lanjing Zhang

Keyword(s):

Fine Needle Aspiration ◽

Meta Analysis ◽

Needle Aspiration ◽

Data Sources ◽

Follicular Neoplasm ◽

Fine Needle ◽

Diagnostic Categories ◽

Risk Of Malignancy ◽

Thyroid Fna ◽

Undetermined Significance

Context.—Fine-needle aspiration (FNA) biopsies have been an important component in the preoperative evaluation of thyroid nodules. Until the introduction of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008, individual institutions had developed their own diagnostic categories. The BSRTC proposed 6 categories in an attempt to standardize reporting of thyroid FNA. Objective.—To present a 15-year experience of thyroid FNA at one institution, including data before and after introduction of the BSRTC. The risk of malignancy is compared with the meta-analysis of high-quality published data. Data Sources.—Data sources were PubMed, a manual search of references, and institutional data. Conclusions.—The diagnostic categories developed at our institution were similar to those proposed by the BSRTC, with best fit into the 6 categories easily accomplished and reported in the final 2 years of the study. Significant differences were noted in the frequencies of cases in diagnostic categories Benign (II; P = .003), Suspicious for follicular neoplasm/Follicular neoplasm (IV; P < .001), and Malignant (VI; P = .003) after the introduction of the BSRTC. Eighteen published articles met the criteria for inclusion in the meta-analysis. The risk of malignancy in each category in our institution was similar to that determined in the meta-analysis, except for Insufficient for diagnosis (I; 20% versus 9%–14%). Meta-analysis showed an overlapping 95% CI of risk of malignancy between Atypia of undetermined significance/Follicular lesion of undetermined significance (III; 11%–23%) and Suspicious for follicular neoplasm/Follicular neoplasm (IV; 20%–29%), suggesting similar risks of malignancy. The use of newer molecular tests for these indeterminate cases may further refine risk assessment.

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Diagnosis of intrathyroidal ectopic thymus in thyroid fine needle aspiration samples

Journal of Clinical Pathology ◽

10.1136/jclinpath-2018-205424 ◽

2018 ◽

Vol 72 (2) ◽

pp. 145-151 ◽

Cited By ~ 3

Author(s):

Weijie Li ◽

Daniel Dim ◽

Lorien Paulson ◽

Douglas Rivard

Keyword(s):

Fine Needle Aspiration ◽

Expression Patterns ◽

Clinical Information ◽

Antigen Expression ◽

Needle Aspiration ◽

Lymphoid Cells ◽

Fine Needle ◽

Ectopic Thymus ◽

Characteristic Appearance ◽

Thyroid Fna

AimsIntrathyroidal ectopic thymus (ITET) is a rare cause of paediatric thyroid nodules. Although ultrasonography of ITET demonstrates a characteristic appearance similar to that of normal thymus, accurate differentiation from other thyroid nodule etiologies by ultrasonography is difficult, and so that fine needle aspiration (FNA) is usually performed for further analysis. The aim of this study was to evaluate the utility of flow cytometry (FCM) in confirming the diagnosis of ITET in thyroid FNA samples.MethodsFive cases of ITET were retrieved from our thyroid FNA database within a 3-year period. Their clinical information, ultrasonographic features, cytology and FCM findings were retrospectively reviewed. The FCM results were compared with those of 22 T-cell acute lymphoblastic leukaemia/lymphoblastic lymphoma (T-ALL/LBL) cases.ResultsThe FNA smears of all five ITET cases demonstrated abundant lymphocytes of variable sizes, which included some immature lymphoid cells. No Hassall’s bodies or atypical epithelioid cells were recognised. By multicolour FCM analysis including antibodies against CD1a, CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD34, TDT and TCR, all ITET cases showed antigen expression patterns consistent with normal thymocyte maturation. All T-ALL/LBL cases exhibited significant immunophenotypic aberrancy.ConclusionsThe diagnosis of ITET based on FNA cytology is often inconclusive. The presence of immature lymphocytes often raises the concern for LBL. FCM with adequate antigen coverage can reliably distinguish ITET from T-ALL/LBL and make the diagnosis of ITET in FNA samples. Avoiding unnecessary further invasive procedures, providing reassurance to clinician and patient, the accurate diagnosis of ITET by FCM in FNA samples is clinically important.

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Ultrasound-guided fine needle aspiration of thyroid nodules: factors affecting diagnostic outcomes and confounding variables

Acta Radiologica ◽

10.1177/0284185116654331 ◽

2016 ◽

Vol 58 (3) ◽

pp. 301-306 ◽

Cited By ~ 7

Author(s):

John Kavanagh ◽

Niall McVeigh ◽

Eoghan McCarthy ◽

Kathleen Bennett ◽

Peter Beddy

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Multivariable Analysis ◽

Needle Aspiration ◽

High Rate ◽

Ultrasound Guided ◽

Factors Affecting ◽

Fine Needle ◽

Factors Associated ◽

Thyroid Fna

Background The incidence of thyroid cancer is increasing in men and women. Fine needle aspiration (FNA) is an accepted technique to assess thyroid nodules but is associated with a high rate of non-diagnostic sampling. Purpose To assess the diagnostic performance of ultrasound-guided FNA of thyroid nodules and identify factors associated with non-diagnostic sampling. Material and Methods A retrospective review of thyroid FNAs was performed between 2006 and 2013. Patient demographics, nodule characteristics, procedural technique, cytology, and complications were recorded. Cytology was categorized THY1-5 based on the British Thyroid Association guidelines. Descriptive and multivariable analysis were conducted to identify factors associated with non-diagnostic sampling. Results A total of 724 procedures were identified with 597 (82.5%) in women, and an overall mean age of 40 years (age range, 17–87 years). Factors associated with a non-diagnostic outcome in the multivariable regression analysis included increasing lesion depth (OR, 1.05 per mm; 95% confidence interval [CI], 1.007–1.10), age (OR, 1.012 per year; 95% CI, 1.0–1.025) and number of FNA passes (1 vs. 4+; OR, 6.07; 95% CI, 2.27–16.21). The complication rate was 1.1% related to perilesional hematomas and vaso-vagal episodes. Conclusion Thyroid FNA is a safe and reliable procedure for cytological assessment of thyroid nodules. Deeper nodules and older patients are more likely to have non-diagnostic samples.

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