Endocrine Abstracts

Purpose: Iatrogenic pseudoaneurysm is a rare but potentially fatal complication of thyroid biopsy. However, the standard management strategy for thyroid pseudoaneurysm is not established. In this study, we aimed to evaluate the incidence, imaging features, clinical manifestations of pseudoaneurysms occurring after thyroid biopsy and to evaluate the efficacy and safety of US-guided percutaneous thrombin injection for pseudoaneurysm.

Materials and Results: From January 2020 to September 2023, 7,256 patients underwent thyroid nodule biopsy in a single institution. We assessed the number of pseudoaneurysms that occurred after thyroid biopsy and were treated with percutaneous thrombin injection. Baseline patient characteristics, imaging features, treatment efficacy, and complication rates were evaluated.

Results: A total of seven cases of pseudoaneurysms developed after biopsy despite more than 30 minutes of manual compression. All cases were associated with core needle biopsy. All patients presented with persistent neck swelling and tenderness after manual compression. Except for one case which showed obliteration following manual compression, the remaining six aneurysms (0.08%) refractory to manual compression were managed with US guided TI. All pseudoaneurysms (100%) were successfully occluded after US guided TI. After TI, no cases required further surgical repair. There were no major complications. Five pseudoaneurysms were located at the thyroid capsule, and two case was located intrathyroidally. The average size of pseudoaneurysms was 0.72 cm (range 0.2-1.3 cm). All pseudoaneurysms (100%) were successfully occluded with less than 500 IU doses of thrombin. After thrombin injection, no cases required further surgical repair. One patient (15%) developed transient loss of consciousness with involuntary movement of the upper extremity after thrombin injection, which spontaneously resolved during observation. The average cost for thrombin injection was $5.72.

Conclusion: US-guided percutaneous thrombin injection is an effective, relatively safe, less invasive method for the management of iatrogenic pseudoaneurysms after biopsy of thyroid nodules.