A 35-year-old woman undergoes core needle biopsy for a suspicious, asymptomatic thyroid nodule that was discovered during a routine physical examination. TSH is normal. After the procedure, the patient develops an expanding hematoma at the biopsy site. She has no personal or family history of bleeding or easy bruising. Which of the following is the most likely diagnosis?

Question

A 35-year-old woman undergoes core needle biopsy for a suspicious, asymptomatic thyroid nodule that was discovered during a routine physical examination.  TSH is normal.  After the procedure, the patient develops an expanding hematoma at the biopsy site.  She has no personal or family history of bleeding or easy bruising.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

This patient developed a hematoma after core needle biopsy for an asymptomatic thyroid nodule. She has no personal or family history of easy bleeding or bruising, making vitamin deficiency and most hereditary bleeding disorders unlikely. Therefore, despite a core needle biopsy being a fairly low-risk procedure, the most likely explanation for the hematoma is insufficient hemostasis following tissue injury from the biopsy. (Choice A) Platelet dysfunction can be seen in patients who take antiplatelet agents (eg, aspirin) or have certain comorbid conditions (eg, liver disease, uremia). Von Willebrand disease can affect platelet function. This otherwise healthy individual (with no family history of bleeding) is unlikely to have platelet dysfunction. Furthermore, most cases would manifest immediately with oozing at the biopsy site. (Choice B) Factor VIII deficiency is seen in hemophilia A, which usually presents in childhood with bruising and mucocutaneus or joint bleeding. Because it is transmitted in an X-linked recessive fashion, male patients are affected; a female patient with no history of bleeding is unlikely to have factor VIII deficiency. (Choice D) Clinically significant thrombocytopenia (eg, primary immune thrombocytopenia) usually manifests with a history of bruising and mucocutaneous bleeding. (Choices E and F) Although vitamin C deficiency (scurvy) can increase the risk of bleeding due to blood vessel fragility, and vitamin K deficiency can increase the risk of bleeding due to coagulation factor (eg, factor II, VII, IX, X) deficiency, this patient's lack of mucocutaneous bruising or bleeding makes these conditions unlikely. In addition, healthy individuals who consume a relatively normal diet are at very low risk for vitamin deficiency. Educational objective: Insufficient hemostasis is the most common cause of postoperative hematoma in patients with no personal or family history of easy bleeding or bruising.

A 35-Year-Old Woman Undergoes Core Needle Biopsy for a Suspicious