Is fine-needle aspiration cytology for thyroid nodules a routine and safe procedure? A series of emergency cervicotomies following FNAC.
OBJECTIVE
Fine-needle aspiration cytology (FNAC) is a widely used diagnostic tool to assess thyroid lesions, with a low morbidity rate. Although neck hematomas following FNAC are reported, only four cases of massive hemorrage resulting in acute airways obstruction have been previously described.


METHODS
We report a series of three emergency cervicotomies for a massive neck hematoma causing acute respiratory distress after a thyroid FNAC.


RESULTS
Endotracheal intubation followed by decompressive cervicotomy and surgical neck exploration was made in all patients. Two patients underwent isthmectomy, while a left thyroid lobectomy plus left lateral neck lymphadenectomy was performed in the third case. Extubation was achieved within 12 h in the ICU. All patients were discharged uneventfully within 72 h.


CONCLUSIONS
Acute thyroid hemorrage is a very rare but possible complication of FNAC, potentially fatal for the patient. Prompt evaluation and intervention is mandatory for patients with rapidly evolving symptoms.
Donatini
Gianluca
G
Unit of General Surgery, Hospital of Massa, Massa, Italy. giacko76@hotmail.com
Masoni
Tiziano
T
D000368:Aged; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D044963:Biopsy, Fine-Needle / Q000009:adverse effects* / Q000379:methods; D003955:Diagnostic Tests, Routine; D004630:Emergencies; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007558:Italy; D009333:Neck / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D018570:Risk Assessment; D017751:Safety Management; D012494:Sampling Studies; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome