Int J Thyroidol.  2018 Nov;11(2):182-188. 10.11106/ijt.2018.11.2.182.

Infection of Thyroid Cyst Occurring 1 Month after Fine-Needle Aspiration in an Immunocompetent Patient

• Park JK
• Jeon EJ

• KMID: 2448991
• DOI: http://doi.org/10.11106/ijt.2018.11.2.182

Abstract

Fine-needle aspiration (FNA) with ultrasonography is considered a minimally invasive and safe procedure. Complications of it are infrequent and occur immediately or within a few days after FNA. Such complications may occur mainly in patients with underlying problems. We here report a rare case of thyroid cystic nodule infection occurring 1 month after FNA in an immunocompetent patient and serial sonographic findings in this patient. A 33-year-old woman with a cystic nodule including partially isoechoic solid areas on the right thyroid gland complained of difficulty swallowing and painful sensations in the right neck 1 month after FNA. On follow-up examination, the cystic nodule and perithyroidal soft tissue were suspicious of infection. The possibility of infection after FNA should be considered even if the patient is immunocompetent in order to prompt evaluation and immediate management with empirical antibiotic therapy to avoid life-threatening complications.

Keyword

Cyst; Fine-needle aspiration; Infection; Thyroid

MeSH Terms

Adult
Biopsy, Fine-Needle*
Deglutition
Female
Follow-Up Studies
Humans
Neck
Sensation
Thyroid Gland*
Ultrasonography

Figure

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  Fig. 1 Thyroid US (transverse view) and Doppler flow showed a 4.12×2.42×4.15 cm partially cystic nodule (arrows) with solid area in the right thyroid gland during the first visit our hospital (A, B) and a local hospital visit (C, D).

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  Fig. 2 (A) FNA cytology showed normal thyroid follicular cells without inflammatory cells at the first visit to our hospital. (B) After 1 month, cytology showed many neutrophils and degenerative colloidal m aterials (Papanicolaou's stain, ×400).

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  Fig. 3 After 1 month, thyroid US in transverse view (A) and longitudinal view (B) showed soft tissue thickening involving the right perithyroidal area and strap muscle (arrows). Three days later after antibiotic therapy, thyroid US showed the changed (C, D).

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  Fig. 4 Thyroid dynamic CT showed a 4.2×3.6×4.8 cm cystic mass (arrows) involving right thyroid gland and compressing the trachea in axial view (A) and in coronal view (B). It showed an ill-defined right thyroid capsule and soft tissue infiltration involving right perithyroidal area, strap muscle and retropharyngeal area. After 6 months, a cystic mass was decreased (C, D).

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  Fig. 5 Thyroid US showed a significant decreases in the size of nodule (arrows) during 6 months (A, B) and 2 year of follow-up (C, D) in transverse and longitudinal views.

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