Rupture of a Superior Thyroid Artery Pseudoaneurysm After Tracheostomy: A Case Report

Minor bleeding after tracheostomy is common, whereas massive hemorrhage is rare and can be catastrophic. We report an 80-year-old man who underwent surgical tracheostomy for prolonged ventilatory support after multiple trauma. The thyroid isthmus was partially divided and reflected caudally to create a tracheal window at the second to third tracheal rings. Hemostasis of the divided edge was achieved with electrocautery (without suturing or vessel ligation), and no pulsatile bleeding or significant vessel was encountered intraoperatively. During recovery, delirium and agitation led to frequent neck motion and marked tracheostomy tube movement. On hospital day 44, he developed sudden pulsatile bleeding from the stoma; temporary control was achieved with orotracheal intubation and local compression, and contrast-enhanced CT revealed a pseudoaneurysm arising from the right superior thyroid artery adjacent to the stoma. Despite initial observation in the absence of active extravasation, rebleeding occurred on hospital day 49 with airway flooding and cardiac arrest. After resuscitation, surgical ligation of the superior thyroid artery eliminated the pseudoaneurysm, but the patient ultimately died from hypoxic encephalopathy. This case highlights the need for prompt vascular evaluation and early definitive management when massive post-tracheostomy bleeding suggests an arterial pseudoaneurysm.