Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10755
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
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.
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.
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.
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.