Extensive cervicomediastinal hematoma due to spontaneous hemorrhage of a parathyroid adenoma: a case report

Broek, J.J. van den; Poelman, Marijn; Wiarda, Bart M.; Bonjer, H. Jaap; Houdijk, Alexander P. J.

doi:10.1093/jscr/rjv039

Cited by 9 publications

(3 citation statements)

References 11 publications

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“…There are only about 100 cases reported with intracystic hemorrhage of parathyroid adenomas in the literatures. Some studies have shown that the use of anti-coagulation drugs ( 4 ) non-steroidal anti-inflammatory drugs ( 5 ) and trauma ( 6 ) may be risk factors; however, the cause of intracystic hemorrhage of parathyroid adenomas is unknown. It is currently believed that if tumor growth is too rapid and the blood supply to the tumor is insufficient, hemorrhage of parathyroid adenomas may occur ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review

Liu

et al. 2021

Front. Endocrinol.

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BackgroundHyperparathyroidism is a common cause of hypercalcemia; however, spontaneous remission after a hypercalcemic crisis caused by an intracystic hemorrhage of parathyroid adenomas is very rare. The question, then, is “What is the best treatment strategy for this type of case?”MethodA 47-year-old male patient with primary hyperparathyroidism and a hypercalcemic crisis is reported. Hypercalcemia was spontaneously relieved thereafter. Postoperative paraffin pathology results indicated an intracystic hemorrhage of bilateral parathyroid adenomas.ResultsAfter the case report, a literature review is also included to summarize the clinical features of this patient and to provide special reference for clinical diagnosis and treatment of similar cases.ConclusionsThe choice of surgical timing for such cases can be made based on the comprehensive consideration of clinical symptoms and changes in parathyroid function.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review

Liu

et al. 2021

Front. Endocrinol.

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“…Emergent surgical intervention is usually required for patients with airway obstruction due to massive hematoma, hemorrhagic shock, and hypercalcemic crisis after parathyroid hemorrhage (4). Otherwise, although persistent hypercalcemia or acute hypocalcemia with tetany can occur after parathyroid hemorrhage (2,4), stable patients can be managed conservatively with follow-up observation given that permanent control of hyperparathyroidism can sometimes occur after autoparathyroidectomy (2,5). However, only 4 cases with recurrence of PHPT after autoparathyroidectomy have been described in the literature, after 4 months (6), 6 months (7), 12 months (8), and even 7 years (9).…”

Section: Discussionmentioning

confidence: 99%

Primary Hyperparathyroidism Accompanied By Recovery Of Parathyroid Blood Flow Three Months After Spontaneous Parathyroid Hemorrhage

Nakatake

Matsubayashi

Hara

et al. 2020

AACE Clinical Case Reports

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Objective: The objective of this report was to describe an unusual case of emerging primary hyperparathyroidism (PHPT) accompanied by recovery of parathyroid blood flow 3 months after spontaneous parathyroid hemorrhage. Methods: Neck images and laboratory tests including serum calcium and parathyroid hormone (PTH) were performed to evaluate parathyroid hemorrhage. Pathologic findings after parathyroidectomy are also presented. Results: A 58-year-old woman developed acute onset of neck pain and swelling with ecchymosis. Computed tomography showed a right para-tracheal hematoma-like lesion behind the thyroid. Ultrasound (US) of the neck revealed a round, hypoechoic nodule measuring 27 × 25 × 18 mm in the right lower thyroid pole without vascular flow. Blood tests showed corrected calcium 9.3 mg/dL (reference range: 8.7–10.3 mg/dL), intact PTH 68 pg/mL (reference range: 10–65 pg/mL). Intact PTH measurement in fine-needle aspirate of the lesion was 339 pg/mL, confirming parathyroid origin. Repeat US after 3 months showed remarkable decrease in lesion size with significant blood flow. Blood biochemistry showed was corrected calcium 10.9 mg/dL, intact PTH 237 pg/mL. She eventually underwent parathyroidectomy, and pathological examination revealed parathyroid adenoma with a tiny thrombus. Conclusion: Spontaneous remission of PHPT after parathyroid hemorrhage has been known to occur sporadically, a phenomenon referred to as autoparathyroidectomy. Although spontaneous remission with permanent improvement of PHPT may be observed, PHPT can recur in the relative short term after parathyroid hemorrhage, and so follow-up blood biochemistry surveillance is requisite. Aso, evaluating parathyroid blood flow using color Doppler US might be useful in verifying the recurrence of PHPT.

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“…28 Although surgical management is successful, the optimum timing for surgery and surgical approach is unclear. Van de Broek et al 33 describe a case of a 79-year-old female on oral anticoagulants, who presented with dyspnea amongst other symptoms (Table 1) requiring elective intubation to control the airway. Laryngoscopy and bronchoscopy revealed compression of both the trachea and esophagus with a subglottic stenosis of the trachea.…”

Section: Discussionmentioning

confidence: 99%

Massive Spontaneous Cervicomediastinal Hemorrhage from a Parathyroid Adenoma

Miller¹,

Dave²,

Ciciulla³

et al. 2019

World Journal of Endocrine Surgery

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Aim:We aimed to describe an unusual case of a patient presenting with subacute neck and chest tightness, and eventual ecchymosis, leading to the diagnosis of a bleeding parathyroid adenoma. We summarize the current literature and discuss important learning points. Background: Significant neck hematoma is a rare condition, and related most frequently to trauma. Rarer causes can include bleeding from the thyroid or parathyroid gland. Case description: A 62-year-old woman presented with subacute neck and chest tightness, and eventual progressive neck swelling and skin discoloration. Initial radiological investigations could not identify the source of bleeding, and subsequent outpatient investigations included a gastrograffin swallow, endoscopic ultrasound, and positron emission tomography. A follow-up contrast CT scan, a sestamibi scan, and USS characterized a right-sided neck nodule to be a likely parathyroid adenoma, confirmed by a raised parathyroid-hormone level and serum calcium. Minimally invasive parathyroidectomy, four months following initial diagnosis, revealed fused tissue planes, with residual petechial hemorrhage. A 813 mg atypical parathyroid adenoma was resected, with hemosiderin being evident within the gland. Conclusion:Review of the literature reveals some similarities to the case described herein, with patients of a similar demographic presenting with symptoms of hoarseness, dysphagia, cervical swelling, and ecchymosis. The physiopathological mechanisms behind such nontraumatic bleeding from the parathyroid gland remains unknown. Clinical significance: A clinical triad of acute neck swelling, hypercalcemia, and neck and/or chest ecchymosis should evoke the potential diagnosis of ruptured parathyroid adenoma. Once the diagnosis is confirmed, minimally invasive parathyroid is a safe approach in experienced hands.

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Extensive cervicomediastinal hematoma due to spontaneous hemorrhage of a parathyroid adenoma: a case report

Cited by 9 publications

References 11 publications

Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review

Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review

Primary Hyperparathyroidism Accompanied By Recovery Of Parathyroid Blood Flow Three Months After Spontaneous Parathyroid Hemorrhage

Massive Spontaneous Cervicomediastinal Hemorrhage from a Parathyroid Adenoma

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