title: Simple core-needle biopsy for thyroid nodule, complicated tinnitus.
abstract: BACKGROUND
  Fine-needle aspiration is the procedure of choice for evaluating thyroid nodules. Core-needle biopsy (CNB) is not included in the American Thyroid Association recommendations for evaluating such nodules. CNB complications are classically bleeding and hematomas. To our knowledge, no case of arteriovenous fistula (AVF) secondary to a CNB has been reported, nor has any case of tinnitus secondary to a post-CNB AVF.
  
  
  OBJECTIVE
  To make the clinician aware of possible vascular complications caused by CNB and the possibility of difficult pathology reading caused by previous CNB.
  
  
  METHODS
  A 44-year-old female is described who was referred to our tertiary care center for left-sided pulsatile tinnitus. She did report having had a CNB right before the tinnitus appeared. Conventional angiography demonstrated a focal AVF originating from the left vertebral artery, with reflux to the left vertebral venous plexus. A 6-mm stent was placed over the site of the fistula via an endovascular approach, which solved both the radiological and clinical documented problems. Moreover, CNB greatly complicated pathology reading once total thyroidectomy was later performed. The suspected area of invasion was an artifact due to the previous biopsies.
  
  
  CONCLUSIONS
  Although many authors recommend a CNB as an alternative modality in cases of inconclusive cytology with fine-needle aspiration, it is not in the American Thyroid Association recommendations. In cases of iatrogenic AVFs caused by a CNB, angiography is recommended both as a diagnostic and therapeutic modality. Stenting the fistula with an endoprosthesis can correct the problem immediately.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Laval University, Quebec, Que., Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bergeron
authors.affiliation: Enfant-Jésus Hospital, Quebec, Que., Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Beaudoin
keywords: Arteriovenous fistula; Core needle biopsy; Stent; Thyroid; Tinnitus
references.citation: Thyroid. 2012 May;22(5):468-75
references.pmid: 22304417
references.citation: J Trauma Acute Care Surg. 2013 Mar;74(3):818-24
references.pmid: 23425741
references.citation: J Urol. 1993 Nov;150(5 Pt 1):1355-9
references.pmid: 8411399
references.citation: Endocr Pract. 2010 May-Jun;16 Suppl 1:1-43
references.pmid: 20497938
references.citation: Thyroid. 2009 Nov;19(11):1167-214
references.pmid: 19860577
references.citation: Thyroid. 2000 Apr;10(4):359-61
references.pmid: 10807065
references.citation: Head Neck. 2012 Oct;34(10):1497-503
references.pmid: 22127851
references.citation: Eur Radiol. 2012 Jul;22(7):1564-72
references.pmid: 22415411
references.citation: Head Neck. 2008 Sep;30(9):1246-52
references.pmid: 18528906