Spontaneous cervical hematoma associated with parathyroid adenoma

Rehman, Habib; Markovski, Milena; Khalifa, Amer Abd-Al-Aziz

doi:10.1503/cmaj.091167

Cited by 17 publications

(19 citation statements)

References 4 publications

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“…Scintigraphy is less widely used and in cases where the parathyroid sestamibi scan has been available, interestingly, the majority have not shown increased uptake in the area of concern. (2) (3) (6) (7). In our case, scintigraphy was a useful adjunct to confirming the diagnosis of parathyroid adenoma as there was a clear area of increased uptake.…”

Section: Discussionmentioning

confidence: 54%

“…In other cases where conservative management is used initially, definitive elective surgical intervention is usually performed within a month of presentation (3) (4). The findings of acute and chronic haemorrhage within the parathyroid gland confirm that delayed elective management does not eliminate the risk of recurrent haemorrhage (6).…”

Section: Discussionmentioning

confidence: 94%

“…The indications for emergency surgery include acute anaemia, hypercalcaemic crisis, airway obstruction and hypotensive decompensation (3) (4). These complications may not arise immediately and this necessitates a period of monitoring in hospital.…”

Section: Discussionmentioning

confidence: 99%

“…The parathyroid glands have a variable vasculature but usually receive the majority of their blood supply from branches of the inferior thyroid artery, occasionally supplemented by the superior thyroid artery. Whereas rupture of a thyroid nodule usually leads to intracapsular haemorrhage, rupture of a parathyroid lesion more commonly causes an extracapsular haemorrhage with extension of blood into the cervical subcutaneous tissues; this is secondary to its relatively thinner capsule (3). Consequently, localised symptoms of parathyroid haemorrhage include ecchymosis, diffuse neck swelling and tenderness.…”

Section: Introductionmentioning

confidence: 99%

“…There is also the potential for the expanding haematoma to compress neighbouring structures, leading to dysphagia and airway compromise (3) (4). In any patient presenting with spontaneous cervical haemorrhage, differential diagnoses such as dissecting aortic aneurysm, dissecting necrotising mediastinitis, atypical extracapsular haemorrhage of a thyroid nodule and iatrogenic trauma to the great vessels should be considered (2) (3). As this presentation of a parathyroid adenoma is so rare, each patient is presently treated on a case by case basis.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous cervical haemorrhage of a parathyroid adenoma

Ulrich

Knee

Todd

2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryHaemorrhage of a parathyroid adenoma is a rare clinical presentation. This report describes a previously fit and well 54-year-old woman who presented with acute neck swelling and pain with an overlying ecchymosis. Admission laboratory tests revealed a raised parathyroid hormone and hypercalcaemia. A computed tomography (CT) scan showed widespread anterior cervical haemorrhage and a lesion at the inferior pole of the left thyroid gland. A working diagnosis of spontaneous haemorrhage from a parathyroid adenoma was made. As she was haemodynamically stable, she was treated conservatively with a period of observation in hospital to monitor for signs of neck organ compression. Follow-up imaging with CT, ultrasound and sestamibi confirmed the likely source of haemorrhage as a parathyroid nodule with significant vascularity. The diagnosis was confirmed on histopathological analysis after elective surgical exploration of the neck 6 months after her presentation. This revealed a benign parathyroid adenoma with evidence of acute and chronic bleeding. The patient made a full recovery with immediate normalisation of her biochemistry post-operatively. Despite developing a hoarse voice in the immediate post-operative period, this resolved completely within 1 month. This case report provides further evidence to support a minimal delay for elective surgery after conservative management to reduce the risks associated with recurrent bleeding.Learning points Haemorrhage of a parathyroid adenoma should be a differential for all cases of acute cervical swelling or ecchymosis with no precipitating factor.The clerking should identify any risk factors for endocrine disease.Blood tests to screen for abnormal parathyroid biochemistry should be performed on admission.Detailed imaging of the neck is essential to identify the source of haemorrhage and risk of compression to vital neck organs.Conservative management is a suitable option for patients who remain haemodynamically stable but all should undergo a period of observation in hospital.Conservatively managed patients should be considered for definitive surgical exploration within a month of presentation to avoid the risks of recurrent bleeding.

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