Wang Ziqiang, Zhang Deguang, Du Qiwei, Zhang Weijun, Liu Nian, Li Rongguo
The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
Department of Thyroid and Head & Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, People's Republic of China.
Head Neck. 2025 Sep;47(9):E96-E100. doi: 10.1002/hed.28148. Epub 2025 Mar 27.
Bilateral thyroid ima artery (TIA) arising from the brachiocephalic trunk is an extremely rare anatomical variation, with no prior cases reported. Recognizing such vascular anomalies is crucial for optimizing surgical outcomes in thyroid and mediastinal procedures, as failure to identify these variations can lead to severe intraoperative complications.
A 28-year-old female presented for surgical management of a thyroid nodule detected during a routine physical examination. The patient reported no significant medical history or prior neck surgeries. Preoperative ultrasonography revealed a high malignancy risk and evidence of cervical and mediastinal lymph node involvement.
Intraoperative findings unexpectedly identified two small arteries originating from the brachiocephalic trunk. These were later confirmed as bilateral TIAs through postoperative imaging and 3D reconstruction.
The patient underwent total thyroidectomy, bilateral modified radical neck dissection, and mediastinal lymph node dissection. Appropriate measures were taken to preserve these vessels during the procedures.
The patient recovered uneventfully, with no complications. Postoperative imaging validated the intraoperative findings, confirming the unique vascular variation.
This case highlights the importance of detailed intraoperative assessment and advanced imaging techniques in surgical planning. Awareness of rare vascular anomalies, such as bilateral TIA, is vital for minimizing surgical risks and improving patient outcomes. This report provides valuable insights into vascular anatomy and clinical practice.
双侧甲状腺最下动脉（TIA）起源于头臂干是一种极其罕见的解剖变异，此前尚无病例报道。识别此类血管异常对于优化甲状腺和纵隔手术的手术结果至关重要，因为未能识别这些变异可能导致严重的术中并发症。
一名28岁女性因在常规体检中发现甲状腺结节前来接受手术治疗。患者报告无重大病史或既往颈部手术史。术前超声检查显示恶性风险高，并有颈部和纵隔淋巴结受累的证据。
术中意外发现两条起源于头臂干的小动脉。术后影像学检查和三维重建后来证实这些为双侧甲状腺最下动脉。
患者接受了全甲状腺切除术、双侧改良根治性颈清扫术和纵隔淋巴结清扫术。术中采取了适当措施保护这些血管。
患者恢复顺利，无并发症。术后影像学检查证实了术中发现，确认了这种独特的血管变异。
本病例强调了详细的术中评估和先进的影像学技术在手术规划中的重要性。认识到罕见的血管异常，如双侧甲状腺最下动脉，对于最大限度地降低手术风险和改善患者预后至关重要。本报告为血管解剖学和临床实践提供了有价值的见解。
