Thoracoscopic excision of mediastinal parathyroid adenomas: a report of two cases

Abstract

Excision of ectopic parathyroid adenomas located within the mediastinum has traditionally relied on open techniques such as full median sternotomy, manubrial split or thoracotomy.1,2 Thoracoscopy is a well-established thoracic surgical technique used to biopsy pleural or pulmonary lesions, drain pleural effusions, and to perform pleurodesis for recurrent pneumothorax and effusions. 3 The application of thoracoscopy to the excision of mediastinal ectopic parathyroid adenomas represents a novel treatment with the potential for greatly reduced complication rates and length of stay compared to conventional open thoracic surgery, 4 and represents a technique that has not yet been reported in British medical literature. Case 1A 70-year-old man with a history of hypertension, repair of a ruptured abdominal aortic aneurysm and transient ischaemic attacks, was referred by his GP for renal investigation because of a raised creatinine of 255 mmol/l. Blood tests revealed corrected calcium of 2.97 mmol/l (range, 2.15-2.6) and parathyroid hormone (PTH) level of 25.8 pmol/l (range, 0.5-4.4). Glomerular filtration rate (GFR) was estimated at 22 ml/min. An ultrasound showed no renal tract abnormality. Tertiary hyperparathyroidism was suspected. A technetium-labelled sestamibi scan was reported as showing no increased uptake in the neck or upper mediastinum. The patient's calcium had risen to 2.99 with a PTH of 45.6, and he was symptomatic with profound lethargy, bone and abdominal pains. He had required two pamidronate infusions, with only minimal improvement. A neck exploration was performed despite the negative sestamibi: this revealed three normal glands, which were left in situ.A computerised tomography (CT) scan subsequently revealed a 1.5-cm enhancing mass adjacent to the

Mediastinal Kitlelere Yaklasimda Vats

“…Her iki vakada sorunsuz olarak taburcu edilmiştir. İngiltere'den bildirilen 70 ve 66 yaşındaki iki vakada anterior mediasten ve posterior trakeal yerleşimli adenomlar VATS ile çıkarılmış ve hastalar 2 ve 4. gün-lerde taburcu edilmiştir (13). Yine üç vakalık bir başka makalede mediastende derin yerleşimli kitleler VATS ile başarıyla rezeke edilmiş ve semptomlarda tamamen düzelme olmuştur (14).…”