Interventional radiology in the management of superior thyroid artery injury which presents as a diagnostic dilemma

Successful interventional management of mediastinal hematoma caused by thyroid ima artery injury

Background

The thyroid ima artery (ThIA) is a rare anatomical anomaly, commonly branching from the brachiocephalic artery. Thyroid ima artery injury can cause severe mediastinal hematoma because its descending branch extends into the mediastinum.

Case presentation

A 91‐year‐old man presented with syncope after a motor vehicle accident. A bruise on the chest was evident. Contrast‐enhanced computed tomography revealed a massive mediastinal hematoma with signs of active hemorrhage. Injury to a descending branch of the ThIA was indicated. Transcatheter arterial embolization (TAE) was successful in stopping the bleeding.

Conclusions

Although a ThIA injury is rare, it can cause serious mediastinal hematoma. Thyroid ima artery injury should be considered as a cause of traumatic mediastinal hematoma. Transcatheter arterial embolization for traumatic ThIA injury is considered a safe and effective treatment.

Profuse bleeding from a pseudoaneurysm of the right superior thyroid artery after tracheostomy

Case

A 70-year-old man was brought to our hospital emergency department with accidental thermal burns. Surgical tracheostomy was carried out on day 8 after admission, followed by several profuse bleeding episodes from the orifice. Contrast-enhanced computed tomography of the neck revealed a small nodule with arterial phase enhancement that was suspected to be a pseudoaneurysm. During emergency angiography, the nodule was revealed to be a pseudoaneurysm arising from the right superior thyroid artery with contrast medium extravasation.

Outcome

The patient underwent transcatheter arterial embolization, which resolved bleeding from the tracheostomy orifice.

Conclusion

Pseudoaneurysm of the superior thyroid artery is an extremely rare and life-threatening tracheostomy complication. All clinicians certified to perform tracheostomy should be acquainted with the various complications and methods for managing life-threatening post-tracheostomy complications.

Superior thyroid artery lesion after US-guided chemical parathyroidectomy: angiographic diagnosis and treatment by embolization

A 71-year-old woman presented with a life-threatening thyroid hemorrhage after US-guided chemical parathyroidectomy. The diagnosis was made by angiography followed by immediate embolization of a pseudoaneurysm of the left superior thyroid artery. Embolization controlled the hemorrhage, obviating the need for surgery. The patient made a full recovery with no evidence of further hemorrhage. Pseudoaneurysm of the superior thyroid artery is a rare cause of hemorrhage and percutaneous embolization is an effective method of treatment.