Spontaneous cervical haemorrhage of a parathyroid adenoma

Abstract

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.

Parathyroid adenoma presenting with spontaneous cervical and anterior mediastinal hemorrhage

“…This patient's presentation was very similar to previous case reports of spontaneous hemorrhage secondary to a parathyroid adenoma [9] —mostly localized as seen with her cervical and mediastinal hemorrhage and symptoms of globus and dysphagia. Like previous studies, she was also of the common demographic of middle-aged women who are otherwise healthy and have relatively asymptomatic hyperparathyroidism.…”

Secondary Mediastinal Bleeding Caused by Parathyroid Adenocarcinoma: A Case Report

“…This case, in terms of clinical and paraclinical characteristics, has many similarities with other cases related to hemorrhage from parathyroid tumors that have been recorded around the world. 1,4 The bone and kidney symptoms of this patient are very typical for primary hyperparathyroidism, and besides, the elevation of PTH and calcium enhance the confirmation of this diagnosis. The disease progression with previous pain and swelling in the neck area and bruises in the chest, neck, and abdomen suggested that the cause could be the rupture of the thyroid or parathyroid.…”

“…Hemorrhage outside the parathyroid glands without risk factors is very rare. 1 The clinical presentation of cervical hemorrhage caused by the rupture of parathyroid tumors was first described by Capps in 1934 after one death due to this cause. 2 Although rare, the disease progresses seriously and could cause death easily.…”

Importance of serum calcium in spontaneous neck haematoma

“…3 7 Ulrich et al argued that patients with VC involvement should be operated within a month, minimising the risk of re-bleeding and recurrent laryngeal nerve injury secondary to tethering. 27 From our review, VC immobility was described in six patients on initial FNE. 3 9 12 16 32 Four patients underwent surgery within 4 weeks, of initial presentation 9 16 26 32 with VC paralysis persisting in two cases.…”