Spontaneous Retropharyngeal Hematoma of a Parathyroid Cyst: Report of a Case

Abstract

A 41-year-old woman presented with severe and sudden anterior neck swelling, pain, and dysphagia. Computed tomography (CT) scan and ultrasound of the neck showed a giant mass in the retropharyngeal space, displacing the trachea and esophagus anteriorly. Aspiration cytology was done, following which extensive cervical and chest ecchymosis occurred and her symptoms immediately improved. A repeat CT scan demonstrated that the cervical giant mass had vanished, but there was a residual mass in the left paratracheal space. Exploratory surgery of the neck revealed a parathyroid cyst with severe adhesion to the surrounding tissues. We considered that a ruptured parathyroid cyst had induced massive hemorrhage into the cervical tissues and mediastinum, but that the hemorrhage had been absorbed. Extracapsular hemorrhage from a parathyroid adenoma or cyst is rare, especially from a parathyroid cyst. In fact, to our knowledge, this represents only the third case of symptomatic spontaneous bleeding of a parathyroid cyst. Nevertheless, this entity should still be considered in the differential diagnosis of all rapidly progressing retropharyngeal masses.

A single-institution 25-year review of true parathyroid cysts

“…Such cysts may occasionally cause compressive symptoms such as dysphagia, dyspnoea, hoarseness or pain, especially when localized in the mediastinum [12][13][14]. Cases complicated by massive haemorrhage into the cervical tissue and the mediastinum have also been reported [15][16][17], but these hematomas are more usually related to the cystic degeneration of an adenoma than with a true non-functional cyst.…”

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

“…Despite typical pathologic findings of parathyroid adenoma, the PTH was within normal limits (1, 2, 6, 8). …”

“…Cervical hematoma presents as acute painful swelling and bruising of neck, and this is associated with dyspnea, hoarseness and dysphagia caused by compression on the surrounding organs such as the trachea, esophagus and recurrent laryngeal nerve (2, 4, 5). …”

“…Parathyroid adenomas usually manifest symptoms related to hypercalcemia such as urinary stone, bone fracture, dehydration and so on (1, 2, 6). It may be encountered as asymptomatic hypercalcemia, but as a very rare situation, it may present as a massive cervical hematoma.…”

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.…”