Fig. 1(A) A 67-year-old man, who presented with a bulging neck mass, had been treated with radiofrequency ablation (RFA) due to a predominantly solid thyroid nodule at right thyroid gland. He had sudden bulging and pain on the right side of his neck 80 days after the RFA. (B, C, D) Computed tomography (CT) and (E, F) ultrasound show volume expansion and discontinuity of the anterior thyroid capsule with nodule content extended to the anterior extra-thyroidal area (arrows) (anterior type). (D) Intra-nodular hyper-attenuating portions on pre-contrast CT represent intra-nodular bleeding. (G) The patient was managed with fluid aspiration and intravenous antibiotics, and the lesion gradually regressed.
Fig. 2(A) A 24-year-old woman, who presented with a bulging neck mass, had been treated with radiofrequency ablation (RFA) due to a predominantly solid thyroid nodule at right thyroid gland. (B) One month after RFA, the nodule decreased in size. However, at 156 days after RFA, the patient complained of neck pain and bulging. (C) Ultrasound shows a heterogeneous echoic lesion around the thyroid capsule (arrows) (posterolateral type). She was treated with compression and observation. (D) After a month, the lesion was completely disappeared.
Fig. 3(A) A 42-year-old female, who presented with bulging neck mass, had been treated with radiofrequency ablation (RFA) due to a predominantly solid thyroid nodule at right thyroid gland. She complained of cough, neck discomfort and mild fever 65 days after RFA. (B, C) On computed tomography (CT) scan, the ablated nodule bulges to medial side and protrudes into the tracheal lumen (arrows) (medial type). (D, E) After conservative management with antibiotics, the lesion was completely disappeared on follow-up CT and ultrasound after 2 months.
Table 1Baseline Characteristics of the 12 Patients with Thyroid Nodule Rupture after RFA
No. of patients |
Sex |
Age, yr |
Nodule site |
Size, mm |
Sonographic composition |
No. of RFAs |
Ablation time |
Maximum ablation power, W |
1 |
F |
75 |
RLP |
8×9×5 |
Predominantly solid |
1 |
NA |
NA |
2 |
F |
16 |
RLP |
24×32×44 |
Predominantly solid |
1 |
8 min 16 sec |
30 |
3 |
F |
42 |
RMP-RLP |
25×34×55 |
Predominantly solid |
1 |
5 min 10 sec |
50 |
4 |
M |
67 |
Right lobe |
38×59×64 |
Predominantly solid |
2 |
13 min (1st) |
50 (1st) |
8 min 40 sec (2nd) |
60 (2nd) |
5 |
F |
53 |
LLP |
10×21×23 |
Predominantly cystic |
1 |
4 min 40 sec |
30 |
6 |
F |
41 |
LLP |
53×47×28 |
Predominantly solid |
1 |
6 min 50 sec |
110 |
7 |
F |
44 |
RLP |
25×17×31 |
Solid |
2 |
30 min (1st) |
70 (1st) |
40 min (2nd) |
50 (2nd) |
8 |
M |
52 |
RLP |
21×25×34 |
Predominantly solid |
1 |
15 min 4 sec |
60 |
9 |
F |
30 |
LMP |
22×28×46 |
Predominantly solid |
2 |
16 min 3 sec (1st) |
60 (1st) |
15 min 24 sec (2nd) |
60 (2nd) |
10 |
M |
20 |
LLP |
15×24×33 |
Predominantly solid |
1 |
12 min 49 sec |
60 |
11 |
F |
17 |
LLP |
17×31×40 |
Predominantly solid |
1 |
11 min 13 sec |
50 |
12 |
F |
30 |
LMP |
10×15×15 |
Solid |
3 |
6 min (1st) |
50 (1st) |
15 min 11 sec (2nd) |
80 (2nd) |
6 min (3rd) |
50 (3rd) |
Table 2Clinical and Imaging Manifestations in the 12 Patients with Thyroid Nodule Rupture after RFA
Patient no. |
Time to rupture from RFA, day |
Symptoms |
Type |
Initial treatment |
Invasive procedure |
Outcome |
1 |
30 |
NA |
Anterior |
NA |
- |
Complete recovery |
2 |
156 |
Sudden neck bulging and pain |
Posterolateral |
Compression |
- |
Complete recovery |
3 |
65 |
Cough, fever, neck discomfort |
Medial |
Antibiotics and observation |
- |
Complete recovery |
4 |
80 |
Sudden neck bulging and pain |
Anterior |
Antibiotics and observation |
Aspiration |
Complete recovery |
5 |
11 |
Sudden neck bulging and pain |
Anterior |
Observation |
- |
Complete recovery |
6 |
48 |
Sudden neck bulging and pain |
Posterolateral |
Observation |
- |
Complete recovery |
7 |
30 |
Sudden neck bulging and pain |
Anterior |
Antibiotics and observation |
Aspiration |
No FU |
8 |
40 |
Sudden neck bulging and pain |
Anterior |
Antibiotics and observation |
- |
Complete recovery |
9 |
57 |
Sudden neck bulging and pain |
Anterior |
Antibiotics and observation |
I&D |
Complete recovery |
10 |
21 |
Sudden neck bulging and pain |
Anterior |
Antibiotics and observation |
I&D |
Complete recovery |
11 |
20 |
Sudden neck bulging and pain |
Anterior |
Antibiotics and observation |
- |
Complete recovery |
12 |
48 |
Sudden neck bulging and pain |
Anterior |
Observation |
- |
Complete recovery |