From the Department of Legal and Forensic Medicine, University of Genova.
Clinical Pathology Unit, IRCCS-Istituto Giannina Gaslini.
Am J Forensic Med Pathol. 2022 Sep 1;43(3):291-295. doi: 10.1097/PAF.0000000000000761. Epub 2022 Aug 4.
Sudden death due to massive hemorrhage after a mini-invasive ambulatory diagnostic procedure is extremely rare. Fine-needle aspiration (FNA) of thyroid nodules is very safe, displaying a low rate of complications, all of which mild and often self-limiting. In few cases do these complications necessitate surgical decompression, and rarely does FNA of a thyroid nodule lead to the death of the patient.We report a case of sudden death caused by respiratory insufficiency after compression of the vascular and nervous structures of the neck and obstruction of the upper airways by hemorrhages dissecting the thyroidal and perithyroidal tissues in a 78-year-old woman. These hemorrhages were the result of vascular lacerations caused during diagnostic FNA of a nodule suspected of malignancy. In such cases, it is important to conduct a complete autopsy and histological analysis to ascertain the origin of massive hemorrhage involving the structures of the neck and to attribute the cause of death to the aforementioned procedure. The forensic pathologist must bear in mind that even extremely small damage, such as that produced by a fine needle, may cause a fatal hemorrhage in subjects with a subverted anatomo-pathological picture (such as, for example, the massive fibrosis of an organ).
在微创门诊诊断程序后发生大量出血导致的突然死亡极为罕见。甲状腺结节的细针穿刺抽吸术（FNA）非常安全，并发症发生率低，所有这些并发症均为轻度且常自行缓解。在少数情况下，这些并发症需要手术减压，而甲状腺结节的 FNA 很少导致患者死亡。我们报告了一例 78 岁女性因颈部血管和神经结构受压以及甲状腺和甲状腺周围组织的血肿引起的上呼吸道阻塞导致呼吸功能不全而突然死亡的病例。这些出血是在对疑似恶性的结节进行诊断性 FNA 过程中引起的血管撕裂所致。在这种情况下，进行全面的尸体解剖和组织学分析以确定涉及颈部结构的大量出血的来源并将死亡原因归因于上述程序非常重要。法医病理学家必须牢记，即使是非常小的损伤，如细针造成的损伤，也可能导致解剖病理图像颠倒（例如，器官的大量纤维化）的患者发生致命性出血。
