Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10755-10762
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10755
Perithyroidal hemorrhage caused by hydrodissection during radiofrequency ablation for benign thyroid nodules: Two case reports
Bo-Wen Zheng, Tao Wu, Zhi-Cheng Yao, Yan-Ping Ma, Jie Ren
Bo-Wen Zheng, Tao Wu, Yan-Ping Ma, Jie Ren, Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Zhi-Cheng Yao, Department of General Surgery, The Third Affiliated Hospital of Sun Yat-sen university, Guangzhou 510530, Guangdong Province, China
Author contributions: Zheng BW reviewed all the literature available about hydrodissection during radiofrequency ablation until June 2022 and was a major contributor to the manuscript; Wu T performed the literature review and made critical revisions of the manuscript; Yao ZC performed the literature review and made critical revisions of the manuscript; Ma YP performed the data acquisition; Ren J guided throughout the writing process as well as performed the radiofrequency ablation procedure; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jie Ren, MD, Professor, Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. renj@mail.sysu.edu.cn
Received: July 4, 2022
Peer-review started: July 4, 2022
First decision: August 1, 2022
Revised: August 15, 2022
Accepted: September 1, 2022
Article in press: September 1, 2022
Published online: October 16, 2022
Abstract
BACKGROUND

Hydrodissection is a widely used technique during radiofrequency ablation (RFA) for benign thyroid nodules. Although it could effectively avoid thermal injury to the surrounding critical structures and achieve complete treatment, routine operation of the remaining needle could cause perithyroidal hemorrhage. In this report, we present 2 cases of perithyroidal hemorrhage during RFA caused by a hydrodissection needle, which have not been reported before.

CASE SUMMARY

A 21-year-old female and a 45-year-old male were admitted for RFA for benign thyroid nodules. Considering that their nodules were adjacent to the recurrent laryngeal nerve, the needle used for hydrodissection was placed and remained between the dorsal capsule of the lateral lobe and the recurrent laryngeal nerve. During the procedure, active bleeding near the needle appeared on ultrasonography (US). Although moderate pressure was quickly applied to the neck for several minutes, contrast-enhanced US (CEUS) still showed an active hemorrhage. A radiofrequency electrode was placed at the bleeding point under the guidance of CEUS to stop the bleeding, and the procedure was finally confirmed to be successful by CEUS, without other complications.

CONCLUSION

Hydrodissection during RFA of benign thyroid nodules was associated with a risk of perithyroidal hemorrhage. The timely recognition of this acute hemorrhage could help in the timely control of the bleeding, and CEUS-guided ablation of the bleeding point could be useful.

Keywords: Complication, Hemorrhage, Hydrodissection, Radiofrequency ablation, Benign thyroid nodules, Case report

Core Tip: Hydrodissection is a widely-used technique during radiofrequency ablation on benign thyroid nodules to avoid thermal injury to the surrounding critical structures. Though it is widely regarded as safe, its routine performing of the remaining needle could cause perithyroidal hemorrhage. We presented 2 cases of perithyroidal hemorrhage during radiofrequency ablation caused by the hydrodissection needle, and additional intervention was used to stop the bleeding, which has no yet been reported. We believe that clinicians should be aware of the possible risk, and the improvement of hydrodissection is needed.