Abstract
BackgroundSpontaneous haemorrhage into a parathyroid adenoma is a rare and potentially life-threatening presentation.Case presentationWe report the case of a 45 year old female recently diagnosed with primary hyperparathyroidism who presented with chest discomfort and acute airway compromise due to spontaneous extracapsular haemorrhage into a parathyroid adenoma. Computed tomography (CT) imaging showed a hypopharyngeal haematoma extending 10 cm into the superior mediastinum. Surgical decompression of the cyst followed by enbloc resection of the parathyroid tumour was performed after elective intubation. Calcium and parathyroid hormone (PTH) levels had fallen prior to surgery and remain normal post-operatively.ConclusionSpontaneous parathyroid haemorrhage should be considered in any patient with unexplained spontaneous cervical haemorrhage, particularly if there is a history of hyperparathyroidism. Initial evaluation of such patients should include serum calcium and PTH as well as imaging.
Highlights
Spontaneous haemorrhage into a parathyroid adenoma is a rare and potentially life-threatening presentation.Case presentation: We report the case of a 45 year old female recently diagnosed with primary hyperparathyroidism who presented with chest discomfort and acute airway compromise due to spontaneous extracapsular haemorrhage into a parathyroid adenoma
Spontaneous parathyroid haemorrhage should be considered in any patient with unexplained spontaneous cervical haemorrhage, if there is a history of hyperparathyroidism
Haemorrhage may be contained within the gland, but often presents as extracapsular haemorrhage extending into the neck or mediastinum, manifesting as acute painful neck swelling, discomfort and cervical ecchymosis
Summary
Spontaneous parathyroid haemorrhage is a rare but potentially life-threatening complication. The diagnosis should be considered in any patient presenting with a spontaneous cervical haemorrhage of unknown aetiology, if there is evidence of hypercalcemia, history of hyperparathyroidism or ecchymosis of the neck or chest wall. Initial evaluation should include a calcium and PTH level these may have fallen if significant glandular haemorrhage has led to infarction of the gland. While some propose conservative management, surgery is the preferred option, in the presence of acute airway compromise
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