Spontaneous cervical-mediastinal hematoma caused by hemorrhage into parathyroid adenoma: A clinical case

INTRODUCTION: Spontaneous cervical-mediastinal hematoma caused by extracapsular rupture of parathyroid gland occurs extremely rarely. There are no standard treatment approaches because of the peculiarities of each case. PRESENTATION OF CASE: We report herewith about a rare case of spontaneous cervical-mediastenal hematoma occured by hemorrhage in parathyroid adenoma, which was detected in an previously absolutely healthy female patient in the age of 29. This woman was hospitalized in 2 days after the manifestation, complaining about a neck ache. Indirect laryngoscopy: right-side larynx paresis. Blood test: parathyroid hormone 843 pg/ml (norm 15-65), ionized calcium 1.8 mmol/l(norm 0.9-1.1). Positive dynamics was observed throughout 8 days of anti-inflammatory therapy. Symptoms of neck organs compression increased acutely at the 9th day. The patient was operated-hematoma lancing with resection of walls. Histological examination discovered the fragments of parathyroid adenoma in the hematoma's wall. Level of ionized blood calcium got normal approximately in 24 h after the surgery. The patient was examined 6 months after the surgery. The patient had no disphagy, voice quality was intact, breathing was not restricted. Level of parathyroid hormone in blood got normal. DISCUSSION: A rareness of this pathology and treatment variability does not allow to choose a unified medical and diagnostic tactics. CONCLUSION: Our case demonstrates that radical correction of primary hyperparathyroidism by excision of hematoma and its fibrous capsule with preservation of thyroid gland is possible in conditions of tense cervical-mediastinal hematoma with inflammation process in the hemorrhage area. (C) 2014 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd.