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. 2021 Jun 28;33(1):82-84.
doi: 10.1093/icvts/ivab043.

What to do when the parathyroid gland is not found during a transcervical exploration?

Georgina Planas  1 , Juan Carlos Trujillo-Reyes  1   2 , Mauro Guarino  1 , Elisabeth Martínez-Téllez  1   2 , Esther Cladellas  1 , Jose Ignacio Pérez  3 , Antonio Moral  2   3 , José Belda  1   2
Affiliations

What to do when the parathyroid gland is not found during a transcervical exploration?

Georgina Planas et al. Interact Cardiovasc Thorac Surg. .

Abstract

The most frequent cause of suboptimal results in a parathyroid adenoma resection is an ectopic location, mainly in the anterior mediastinum. These cases may not always be resected through a traditional cervical access. We present 2 cases of primary hyperparathyroidism who underwent an unsuccessful bilateral cervical exploration due to parathyroid tissue located inside the thymic gland. A video-assisted thoracoscopic surgery thymectomy with intraoperative determination of blood parathormone levels was performed. A 50% reduction of intraoperatory parathyroid hormone blood from the highest basal level at 5 and 10 min after resection was obtained. Final pathological results showed an intra-thymic parathyroid adenoma in the first patient and an intra-thymic focus of parathyroid hyperplasia in the second patient. In conclusion, video-assisted thoracoscopic surgery thymectomy could be the optimal approach to resect ectopic parathyroid adenomas located in the anterior mediastinum.

Keywords: Mediastinal disease; Parathormone; Parathyroid adenoma; Thymectomy; Video-assisted thoracic surgery.

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Figures

Figure 1:
Figure 1:
(A) Fluorocholine positron emission tomography–computed tomography shows a hypermetabolic lesion in the anterior mediastinum. (B) Chest computed tomography reveals a lesion anterior to the innominate vein. (C) The patient is positioned in a 45° left lateral decubitus with a 30° abduction of the right arm. (D) Thymic veins must be clamped to avoid an important bleeding. The black arrow shows a thymic vein.
See this image and copyright information in PMC

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