Thoracoscopic excision of mediastinal parathyroid adenomas: a report of two cases

Abstract

Two patients with primary hyperparathyroidism caused by solitary ectopic mediastinal parathyroid adenomas have been successfully treated by thoracoscopic excision. The patients were not suitable for open thoracic surgery. Both had right-sided adenomas confirmed by sestamibi and computerised tomography - one adjacent to the oesophagus at the level of D3, the other anterolateral to the ascending aorta. Both procedures were performed through one 12-mm camera port and two 5-mm operating ports, and were uncomplicated, with 30-45 minutes skin-to-skin operating time. Both patients were well enough to be discharged the next day, and both rapidly became normocalcaemic. At follow-up, neither had developed any complications. In selected cases, where an ectopic adenoma lies immediately deep to the mediastinal pleura, thoracoscopic excision offers considerable advantage over open thoracic surgery.

Figure 1

CT scan showing the ectopic parathyroid adenoma in Case 1 adjacent to the oesophagus, behind the trachea, at the level of the body of D3.

Figure 2

Intra-operative photograph demonstrating the excision of the adenoma in Case 1.

Figure 3

Sestamibi SPECT scan clearly demonstrating a hot spot of isotope activity in the anterior mediastinum in front of the ascending aorta.

Figure 3

Sestamibi SPECT scan clearly demonstrating a hot spot of isotope activity in the anterior mediastinum in front of the ascending aorta.

Figure 3

Sestamibi SPECT scan clearly demonstrating a hot spot of isotope activity in the anterior mediastinum in front of the ascending aorta.

Figure 4

CT reconstruction clearly showing ectopic parathyroid adenoma in front of the ascending aorta (arrowed).

Figure 5

Intra-operative photograph of mediastinal parathyroid adenoma in Case 2 being dissected free of the ascending aorta, with epicardial fat visible beneath it.