A 63-year-old woman was referred by her cardiologist because of rapid growth of an anterior cervical mass. The patient had a history of severe vascular atherosclerotic disease, requiring multiple prosthetic vascular surgery, among which thoracic aorta surgery, atrial fibrillation requiring coumadin and chronic respiratory failure. On admission, the patient presented with a 7 cm firm mass, regularly growing for 2 months, adherent to the cervical skin, highly suggestive of thyroid anaplastic carcinoma. Immediately performed, a CT scan demonstrated an anterior cervical lesion, possibly related to an old hematoma. Fine needle biopsy aspiration revealed after thin prep filtration inflammatory cells (macrophages, neutrophil leukocytes and lymphocytes), but no tumor cell. Needle evacuation was poorly successful, and further, regular follow up was decided. No change in the cervical mass volume was observed.
Discussion: A firm rapidly and regularly growing anterior cervical swelling is highly suggestive of anaplastic thyroid carcinoma. Lymphomas and Riedels thyroiditis may also be evoked. By contrast, intrathyroidal hemorrhage is usually acute and painful. Hematomas of the thyroid region (except after thyroidectomy) are rather unusual. In our case, it was induced by venous flow changes as a consequence of surgical ligation of left innominate vein following aortic replacement, leading to highly increased subcutaneous straining of turgescent collateral veins. Blood leakage was probably enhanced by antivitamin K treatment (especially when irregularly controlled and excessive) and an initial muscular effort (carrying a sofa).
Conclusion: Regularly growing cervical hematomas may occur months after aortic surgery, due to venous straining rearrangement and enhanced by anticoagulation, and therefore clinically mimic anaplastic thyroid carcinoma.
03 - 07 May 2008
European Society of Endocrinology