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Case Reports
. 2019 Feb;98(5):e14347.
doi: 10.1097/MD.0000000000014347.

Parathyroid adenoma presenting with spontaneous cervical and anterior mediastinal hemorrhage: A case report

Sohini Khan  1 , Charles C Choe  2 , Ahmed Shabaik  3 , Michael Bouvet  1
Affiliations
Case Reports

Parathyroid adenoma presenting with spontaneous cervical and anterior mediastinal hemorrhage: A case report

Sohini Khan et al. Medicine (Baltimore). 2019 Feb.

Abstract

Rationale: Spontaneous anterior cervical or mediastinal hemorrhage is a rare presentation of parathyroid adenoma.

Patient concerns: A 69-year-old woman presented with neck hematoma and dysphagia and was found to have a soft tissue mass adjacent to her thyroid gland as seen on MRI and neck ultrasound.

Diagnosis: Laboratory testing demonstrated elevated calcium and parathyroid hormone supporting diagnosis of parathyroid adenoma.

Interventions: She underwent right inferior parathyroidectomy and en bloc right hemithyroidectomy due to significant fibrosis.

Outcomes: Pathology confirmed hypercellular parathyroid and normal thyroid tissue. Postoperatively, patient's calcium and parathyroid hormone levels had normalized.

Lessons: In conclusion, imaging may not always be specific in identifying the source of neck hematoma and so laboratory studies should be done to rule out parathyroid adenoma as the underlying etiology.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Progression of neck edema and ecchymosis days 2–9 (A–C) after initial symptoms.
Figure 2
Figure 2
Axial MRI showing mass present on right side of neck arising from right lobe of thyroid measuring 1.4 × 2.2 × 2.3 cm with mild edema present surrounding the mass.
Figure 3
Figure 3
Ultrasound shows mass in lower pole of right lobe of thyroid with solid and vascular measuring 1.57 × 1.42 × 2.25 cm in maximal dimension.
Figure 4
Figure 4
Parathyroid adenoma after surgical excision.
Figure 5
Figure 5
Hypercellular parathyroid gland with central hemorrhage, hemosiderin-laden macrophages, fibrosis, and scarring; hematoxylin and eosin stain (A: 100×, B: 200×).
See this image and copyright information in PMC

References

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