A Rare Case of Fatal Thyroid Hemorrhage After Fine-Needle Aspiration: Case Report and Review of the Literature

Abstract

Sudden death due to massive hemorrhage after a mini-invasive ambulatory diagnostic procedure is extremely rare. Fine-needle aspiration (FNA) of thyroid nodules is very safe, displaying a low rate of complications, all of which mild and often self-limiting. In few cases do these complications necessitate surgical decompression, and rarely does FNA of a thyroid nodule lead to the death of the patient.We report a case of sudden death caused by respiratory insufficiency after compression of the vascular and nervous structures of the neck and obstruction of the upper airways by hemorrhages dissecting the thyroidal and perithyroidal tissues in a 78-year-old woman. These hemorrhages were the result of vascular lacerations caused during diagnostic FNA of a nodule suspected of malignancy. In such cases, it is important to conduct a complete autopsy and histological analysis to ascertain the origin of massive hemorrhage involving the structures of the neck and to attribute the cause of death to the aforementioned procedure. The forensic pathologist must bear in mind that even extremely small damage, such as that produced by a fine needle, may cause a fatal hemorrhage in subjects with a subverted anatomo-pathological picture (such as, for example, the massive fibrosis of an organ).

FIGURE 1

Massive hemorrhagic infarct involving the neck muscles and subcutaneous tissue of the supraclavicular region, especially on the right.

FIGURE 2

Organs of the neck after fixation in formalin. A, Area of hemorrhagic infiltration at the level of the supraglottic plane, surrounding the right lateral region of the esophagus. B, Interruption of a few millimeters along the vertical axis of the right jugular vein.

FIGURE 3

Histological findings. A, Granulomatous process with foreign body-type giant cells, reactive to colloid extravasation and microhemorrhages in the thyroid gland (hematoxylin and eosin [H&E], ×20). B, Marked hemorrhagic extravasations in the thyroid tissues (H&E, ×20). C, A medium-caliber vein of the perithyroid tissues with lacerated wall (H&E, ×20). D, Laceration of small thickness of the jugular vein, in the absence of inflammatory reaction (H&E, ×20).