Is fine-needle aspiration cytology for thyroid nodules a routine and safe procedure? A series of emergency cervicotomies following FNAC

Purpose Fine-needle aspiration cytology (FNAC) is a widely used diagnostic tool to assess thyroid lesions, with a low morbidity rate. Although neck hematomas following FNAC are reported, only four cases of massive hemorrage resulting in acute airways obstruction have been previously described. Methods We report a series of three emergency cervicotomies for a massive neck hematoma causing acute respiratory distress after a thyroid FNAC. Results Endotracheal intubation followed by decompressive cervicotomy and surgical neck exploration was made in all patients. Two patients underwent isthmectomy, while a left thyroid lobectomy plus left lateral neck limphadenectomy was performed in the third case. Extubation was achieved within 12 h in the ICU. All patients were discharged uneventfully within 72 h. Conclusions Acute thyroid hemorrage is a very rare but possible complication of FNAC, potentially fatal for the patient. Prompt evaluation and intervention is mandatory for patients with rapidly evolving symptoms.