Transcervical excision of a giant mediastinal parathyroid adenoma

[...]laboratory tests revealed inappropriately raised parathyroid hormone (PTH) levels of 19 pmol/L, normal vitamin D levels and raised urinary calcium in keeping with a diagnosis of primary hyperparathyroidism. Parathyroid localisation studies revealed an unremarkable neck ultrasound, but technetiu...

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Bibliographic Details
Published in:BMJ case reports 2019-02, Vol.12 (2), p.bcr-2018-228292
Main Authors: Miller, Benjamin John, Isaacs, Kim, Khan, Emran, Palazzo, Fausto F
Format: Article
Language:English
Subjects:
Adenoma - diagnostic imaging
Adenoma - pathology
Adenoma - surgery
Biochemistry
Case reports
Humans
Images In
Incidental Findings
Male
Mediastinal Neoplasms - diagnostic imaging
Mediastinal Neoplasms - pathology
Mediastinal Neoplasms - surgery
Mediastinum - diagnostic imaging
Mediastinum - pathology
Middle Aged
Ostomy
Parathyroid Neoplasms - diagnostic imaging
Parathyroid Neoplasms - pathology
Parathyroid Neoplasms - surgery
Parathyroidectomy
Surgery
Thorax
Thyroid gland
Treatment Outcome
Tumors
Ultrasonic imaging
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Summary:[...]laboratory tests revealed inappropriately raised parathyroid hormone (PTH) levels of 19 pmol/L, normal vitamin D levels and raised urinary calcium in keeping with a diagnosis of primary hyperparathyroidism. Parathyroid localisation studies revealed an unremarkable neck ultrasound, but technetium sestamibi imaging demonstrated an unusual linear region of increased intensity to the left of the mediastinum (figure 1) with similar washout to thyroid tissue suggesting possible ectopic thyroid tissue. Giant (>3.5 g) mediastinal parathyroid adenomas are extremely rare entities, with published instances limited to a handful of case reports.1 2 They are predominantly located in the anterosuperior mediastinum and may require a range of surgical approaches including transcervical, thoracoscopic, median sternotomy and thoracotomy.3 The latter three approaches are often preferred in deeper set adenomas, although sternotomy and thoracotomy have been shown to result in longer hospital stays and higher complication rates.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2018-228292