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

Abstract

IntroductionSpontaneous 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 caseWe 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.DiscussionA rareness of this pathology and treatment variability does not allow to choose a unified medical and diagnostic tactics.ConclusionOur 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.

A surgical case of mediastinal hematoma caused by a minor traffic injury

“…Mediastinal hematoma without major thoracic injury is reported to be extremely rare [1]. According to previous reports, various causes have been reported: thyroid gland rupture by blunt neck trauma [2,3], rupture of the inferior thyroid artery by repetitive Valsalva maneuver [1], violent coughing [4], spontaneous rupture of an inferior thyroid artery aneurysm [5], and hemorrhage in a parathyroid adenoma [6]. The thyroid gland has a rich blood supply, and we could not find bleeding from the inferior thyroid artery and mediastinum.…”

Secondary Mediastinal Bleeding Caused by Parathyroid Adenocarcinoma: A Case Report

“…Therefore, most of those cases were followed up for a while before surgical intervention. 5,9 This can be explained that this patient’s hyperparathyroidism state was not detected and treated for a long time, so the size of the parathyroid tumor is quite large, and the blood vessels that nourish the tumor are also correspondingly large. Once bleeding happens, severe hemorrhage could happen in a short time.…”

Nontraumatic Parapharyngeal Haematoma: A Rare Lesion

“…This is a very rare clinical situation: until 2009, only 28 cases of spontaneous cervical haematoma caused by extracapsular rupture of the parathyroid gland were reported [ 4 ]. Expansion and bleeding outside the capsule may be due to the fact that parathyroid glands containing tumors have relatively thin and weak capsules [ 5 ].…”