Iatrogenic Pseudoaneurysm of the Superior Thyroid Artery

• DOI: 10.7863/jum.2004.23.12.1675
• Publication Date: 2017-01-09T23:41:14Z
• Authors: Halil Celik; Cem Yücel; Suna Oktar; Zehra Karadag; Hakan Özdemir
• Keywords: Pseudoaneurysm; Superior thyroid artery; Inferior thyroid artery

A pseudoaneurysm is a pulsating hematoma that results from disruption of portion the arterial wall. Clotting occurs in peripheral limits hematoma, whereas center remains fluid and communicates with lumen, causing pulsatile mass. Femoral artery pseudoaneurysms are potentially serious complications catheterization. Various studies have shown rate after cardiac catheterization 1.6%, it 0.7% to 6.3% percutaneous transluminal coronary angioplasty.1 arising superior thyroid (STA) extremely rare. Two cases STA been reported ultrasonographically guided chemical parathyroidectomy radiotherapy for hypopharyngeal cancer.23 To best our knowledge, any case an due fine-needle aspiration biopsy has not reported. We report during biopsy, which showed spontaneous thrombosis. 39-year-old woman 1.5-cm-diameter solitary nodule right upper pole her gland was admitted radiology department biopsy. Ultrasonographically performed 20-gauge needle by freehand technique. The ultrasonographic scanning plane axial, direction mediolateral. During placement needle, within seconds gulping, hypoechoic collection appeared anterior gland. Within minutes, 3-cm heterogeneous echogenic swirling mass (Figure 1A) identified adjacent STA, flow on color Doppler imaging 1B). Spectral tracing neck typical to-and-fro pattern 1C). On examination, patient conscious, cardiovascular condition stable. She had considerable swelling. There no evidence stridor, patient's chest clear auscultation. Iatrogenic female patient. A, Gray scale sonogram showing (arrow) (arrowheads) B, Color image (arrow). C, characteristic pattern. D, obtained third day total thrombosis (arrows). E, normal day. F, Control second month totally absorbed. After diagnosis established, compression attempted immediately. Because there bony structure behind area could support compression, transcutaneous effective closing communication between lumen. Therefore, we decided wait serial examinations. Examinations were repeated every day, became smaller, thrombus filled whole cavity 1, D E). In control month, found be absorbed 1F). tangential injury vessel wall, subsequent hemorrhage into defect formation contained adventitia or perivascular tissue. systole high intra-arterial pressure, antegrade toward pseudoaneurysm, diastole, retrograde. Pseudoaneurysm well-known complication vascular injury. Real-time ultrasonography provides simple, reliable, inexpensive assessment. signs consist expansile pulsations point artery. sign observed at turbulent arterial-like helps confirm real-time diagnosis. Treatment options femoral include conservative measures, surgical repair, therapy (UGCT), transcatheter coil embolization, thrombin injection. traditional repair iatrogenic treatment option. However, expense prolonged hospitalization. Associated wound infections scarring make future procedures difficult. induces transiently occluding blood compressing ultrasonic probe. Success rates varied widely 55% 90% published series. Obesity, large concomitant anticoagulation therapy, groin discomfort predictors UGCT failure. contraindicated presence infection, tense limb-threatening ischemia.4 Long-standing lesions as unsuitable UGCT, but Schaub et al1 3 older than 4 weeks successfully repaired all them. sporadic previous reports about successful patients receiving oral anticoagulant therapy. one study, 14 26 anticoagulants treated UGCT.1 It many postcatheterization will thrombose spontaneously thus require only reduced activity evaluation. Several features suggested predisposing healing. longer shorter time required healing process. Paulson al5 small volumes lumen more likely those natural history stable benign frequently resolution, allows properly selected without surgery. Toursarkissian al6 89% they resolved spontaneously. prompt criteria included size greater cm, expansion, expansion clinical severe local symptoms, need long-term inability follow-up, simultaneous another intervention.6 limited number concerning non–femoral literature. Soudack al7 child involved motor vehicle collision who liver lacerations development hepatic pseudoaneurysms. case, embolization performed, regressed spontaneously.7 Spontaneous occlusion traumatic false aneurysm peroneal described Kocakoc al.8 standard protocol because relative rarity aneurysms. 2 involving previously. first known hypertension, renal failure, secondary hyperparathyroidism whom occurred parathyroidectomy. made angiography selective embolization.2 ruptured dorsal pharyngeal wall squamous cell carcinoma probably induced radiation vasculopathy embolization.3 patient, examination. stable, angiographic planned. did close preferred conclusion, this reported, unique occurrence obviated further radiologic intervention.