Cervical and mediastinal hematoma: presentation of an asymptomatic cervical parathyroid adenoma: case report and literature review

Abstract

The spontaneous rupture with extracapsular hemorrhage of a cervical parathyroid adenoma is a rare cause of cervical and mediastinal hematoma. We describe this case to emphasize that a failure to consider this diagnosis may result in delayed operative intervention with potentially fatal complications.

A Case of an Acute Cervicomediastinal Hematoma Secondary to the Spontaneous Rupture of a Parathyroid Adenoma

“…Over the last 80 years, approximately 20 cases of acute hemorrhage resulting from the spontaneous rupture of the parathyroid glands have been reported in the English literature. A previous study reported that the causes of these hemorrhages include parathyroid glands that are enlarged by adenomas, [1][2][3][4][5][6][7][8][9] primary or secondary hyperplasia, [10][11][12] cysts [13][14][15] and carcinomas. 16) Some authors report that blood supplies may occasionally fail to meet the increased demands caused by these lesions.…”

“…However, some patients are asymptomatic and present with normal serum levels of PTH and calcium. [3][4][5]7) Because of its rarity, a spontaneous rupture of a parathyroid adenoma is difficult to detect in patients who lack a diagnosis of adenoma, hyperplasia or pathologies of the parathyroid glands. The first case 1) was diagnosed by autopsy.…”

Non-Functional Parathyroid Adenoma Presenting as a Massive Cervical Hematoma: A Case Report

“…The hemorrhage may be localized within the parathyroid gland, but it is often presented as extracapsular hemorrhage. The clinical symptoms depend on the amount and the location of hematoma, and various clinical presentations associated with the change in the PTH level may also be shown (7). …”

“…Second, the path of PTH secretion may be transformed into the lumen of the cyst instead of the blood stream. Third, the pressure caused by the hematoma may interfere with the blood flow around the adenoma (7, 9, 10). However, we did not verify if there was necrotic change of the parathyroid adenoma or an increased PTH level in the cyst in this case.…”

Parathyroid Hemorrhage Occurring after Administration of Cinacalcet in a Patient with Secondary Hyperparathyroidism

“…Emergency resection of the affected gland is performed in severe cases of massive extracapsular hemorrhage invading the surrounding organs and tissues (1,4), however there are some cases in which the parathyroid function is spontaneously normalized by autoinfarction following intracapsular hemorrhage (2,5). Parathyroid bleeding has also been reported to occur in hemodialysis patients with secondary hyperparathyroidism (SHPT) in whom parathyroid activity is elevated (6)(7)(8).…”