Iatrogenic Pseudoaneurysm from Needle Aspiration of Thyroid Lesion: A Rare but Potentially Life-Threatening Complication

Safety and Efficacy of Ultrasound-Guided Thrombin Injection for Pseudoaneurysms Arising after Ultrasound-Guided Biopsy of Thyroid Nodules

Iatrogenic pseudoaneurysm is a rare but potentially fatal complication of a thyroid biopsy. However, a standard management strategy has not yet been established. We aimed to evaluate the efficacy and safety of ultrasound (US)-guided thrombin injection (TI) for thyroid pseudoaneurysms. This retrospective study included 7256 patients who underwent thyroid biopsy and TI from January 2020 to January 2024. The technical success, clinical efficacy, and complication rates were evaluated. A total of 0.1% (7/7256) of pseudoaneurysms developed after thyroid biopsy. Except for 1 case that showed obliteration with manual compression, the remaining 6 refractory aneurysms (0.08%) were managed with US-guided TI. All cases (100%) were successfully occluded with US-guided TI. No major complications were observed. One patient (16.7%) developed transient loss of consciousness, which spontaneously resolved within a few seconds. US-guided TI is an effective, relatively safe, and minimally invasive method for managing pseudoaneurysms after thyroid biopsy.

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.

Iatrogenic thyroid pseudoaneurysm following thyroid nodule radiofrequency ablation

A 54-year-old Chinese woman presented for radiofrequency ablation (RFA) of benign thyroid nodules. A few hours after the procedure, the patient developed neck swelling and tenderness. Doppler ultrasound (US) images of the neck revealed haematoma with a vascular hypoechoic mass at the RFA site, suspicious for pseudoaneurysm. These findings were confirmed on subsequent on-table fluoroscopy following direct US-guided needle puncture and injection of contrast, demonstrating opacification of the mass and extravasation. Successful occlusion of the pseudoaneurysm was performed using US-guided thrombin injection. The patient made a good recovery with follow-up US 1 month later showing no recurrence of haematoma or pseudoaneurysm.