Ultrasound-Guided Assessment and Management of Seroma after Total Thyroidectomy: A Prospective Study

Abstract

Background: A complication that is known after total thyroidectomy is seroma, which is a collection of serous fluid in the surgical dead space after the removal of the drain. To avoid wound-related morbidity, early detection and minimally invasive management are key. In this clinical scenario, ultrasound has proven to be a very accurate, non-invasive diagnostic and therapeutic tool.

Objective: To assess the accuracy of ultrasound for diagnosing postoperative seroma and the effectiveness and safety of ultrasound-guided aspiration for seroma management in patients undergoing total thyroidectomy.

Methods: The study was a prospective study that was carried out in Al-Tibri Medical College and Hospital from March 2025 to August 2025. A total of 50 consecutive patients underwent total thyroidectomy for multinodular goiter. A sonogram was performed on days 3 to 4 after the removal of the drain to evaluate for the presence of seroma. Ultrasound-guided aspiration was used for the treatment of confirmed seroma cases.

Results: Seroma was detected in 15 (30%) patients. All cases were 100% diagnosed using ultrasound. Up to 20 ml per aspiration was enough for 10 (66.7%) patients. Of the five (33.3%) patients who did need serial aspirations, adjunct pressure dressing was used. There were no re-explorations, wound infections, or hospital re-admissions among all patients.

Conclusion: Ultrasound can be a reliable, real-time diagnostic tool for the detection and quantification of postoperative seroma. The ultrasound-guided aspiration is a safe, less invasive, and effective management tool and avoids surgical re-intervention.