Parathyroid adenoma causing spontaneous cervical hematoma: two case reports

Abstract

Background: Although spontaneous rupture of a cervical parathyroid adenoma with extracapsular hemorrhage is rare, it may cause cervical and mediastinal hematoma, leading to potentially fatal consequences.

Case presentation: The first case was a 76-year-old Asian female who presented with pharyngeal discomfort and anterior chest ecchymosis. Endoscopic investigation showed submucosal hemorrhage in the pharynx and larynx. The second case was a 62-year-old Asian male who presented with anterior chest ecchymosis and suspected of a ruptured blood vessel. Both cases were diagnosed parathyroid adenoma with extracapsular bleeding by hypercalcemia, high levels of intact parathyroid hormone and presence of a nodule behind the thyroid. Both cases were treated with excision of tumor 7 months after initial presentation. After surgery, serum calcium and parathyroid hormone levels had decreased to normal level in both cases.

Conclusion: Extracapsular bleeding of a parathyroid adenoma should be considered in the differential diagnosis of non-traumatic neck hematoma.

Fig. 1

Case 1. Fiberoptic laryngoscopy. a Nasopharynx, b oropharynx, c, d larynx, submucous bleeding of the true vocal cords is evident

Fig. 2

Case 1. Axial images of a CT of the neck and chest without contrast demonstrate diffuse soft tissue density posterior to the oropharynx, hypopharynx and larynx, displacing these structures anteriorly away from the spine (a, b). A more focal mass-like area of rounded soft tissue density is seen posterior to the left thyroid lobe, suggestive of a focal lesion (arrow) (c). Diffuse abnormal soft tissue density is also seen within the upper mediastinum (d)

Fig. 3

Case 1. a Delayed image of 99mTc-MIBI (99m-technetium-ethoxysobutylisonitrile) scintigraphy showing abnormal uptake on the left side of the parathyroid area, b SPECT-CT showing abnormal uptake in the same location

Fig. 4

Case 1. a Macro specimen (cut surface) 35 × 25 × 15 mm slight hemorrhagic area is detected right under the capsule (arrow), b HE stain ×40. The tumor is surrounded by fibrous capsule (arrow)

Fig. 5

Case 2. a Axial image of a CT of the neck and chest with contrast demonstrate diffuse soft tissue density (arrow) in the posterior mediastinal space. b Axial image of a CT of the neck and chest without contrast examined 2 weeks after admission. The diffuse lesion has disappeared and a mass (arrow) posterior to the thyroid can be clearly seen

Fig. 6

Case 2. a Macro specimen (cut surface) 28 × 19 × 17 mm hemorrhagic area is evident. b HE stain ×400. Phagocytosis of hemosiderin by macrophages is evident (arrow)