Fine-needle aspiration biopsy of the thyroid can cause massive hematoma even in the absence of anticoagulant use, hypertension, or thrombocytopenia.
Massive post-FNAB thyroid hematoma may occur without typical risk factors; this case leaves open true incidence and optimal monitoring.
Chest computed tomography (CT) was performed in a 62year-old woman in order to detect the primary site of a metastatic brain tumor. Thyroid nodules were observed (Picture A). The patient underwent an ultrasound-guided fineneedle aspiration biopsy (FNAB) of a hypoechoic 16.7 22.69.8-mm nodule on the right side using a 22-gauge needle. No anticoagulant or antiplatelet agents were administered. No hypertension or thrombocytopenia were observed. Three hours after undergoing the FNAB, the patient experienced severe neck swelling and pain. CT scans showed markedly enlarged thyroid lobes containing hyperdense ar-eas, thus indicating the presence of hemorrhaging (Picture B and C). The hematoma decreased in size without surgery. The obtained specimen did not indicate malignancy.
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Yoshida et al. (2012) studied this question.
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