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BackgroundAlthough spontaneous rupture of a cervical parathyroid adenoma with extracapsular hemorrhage is rare, it may cause cervical and mediastinal hematoma, leading to potentially fatal consequences.Case presentationThe first case was a 76-year-old Asian female who presented with pharyngeal discomfort and anterior chest ecchymosis. Endoscopic investigation showed submucosal hemorrhage in the pharynx and larynx. The second case was a 62-year-old Asian male who presented with anterior chest ecchymosis and suspected of a ruptured blood vessel. Both cases were diagnosed parathyroid adenoma with extracapsular bleeding by hypercalcemia, high levels of intact parathyroid hormone and presence of a nodule behind the thyroid. Both cases were treated with excision of tumor 7 months after initial presentation. After surgery, serum calcium and parathyroid hormone levels had decreased to normal level in both cases.ConclusionExtracapsular bleeding of a parathyroid adenoma should be considered in the differential diagnosis of non-traumatic neck hematoma.

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