Life-Threatening Neck Hematoma After Fine-Needle Aspiration of a Thyroid Nodule in a Patient With End-Stage Renal Disease

Background/Objective: Ultrasound-guided fine needle aspiration (FNA) of thyroid nodules is a widely performed and generally safe procedure with a low complication rate. While minor bleeding and small hematomas are relatively common, the occurrence of a large, life-threatening hematoma is exceedingly rare. This case report describes a patient who developed a delayed, severe cervical hematoma several days after undergoing thyroid FNA. We review contributing risk factors and propose strategies to help minimize such complications. Case Report: A 68-year-old female patient with past medical history of end stage renal disease (ESRD) underwent FNA for a suspicious left thyroid nodule. Patient was not taking anticoagulants or antiplatelet medication and had no known coagulopathy other than ESRD. While initially the procedure was well tolerated without complications, 3 days later the patient presented with large neck swelling and airway compromise. She was subsequently intubated and underwent drainage of 5.2 × 3.1 × 12.3 cm retropharyngeal hematoma. The patient recovered with mild persistent hoarseness of voice. Discussion: Though rare, delayed hematoma after thyroid FNA can be life-threatening. Risk may be higher in patients with ESRD, highly vascular nodules, or when certain biopsy devices are used. Coagulation labs may not fully reflect bleeding risk in dialysis patients. Clinicians should educate patients about warning signs such as neck swelling or breathing changes and consider closer follow-up in high-risk cases. Conclusion: Thyroid FNA is generally safe, but rare delayed bleeding complications can occur. Early recognition and airway management are essential for good outcomes.