Abstract
IntroductionThe spontaneous rupture of a parathyroid adenoma accompanied by extracapsular hemorrhage is a rare, potentially fatal, condition and is a cervicomediastinal surgical emergency.Case presentationThis report describes an atypical two-step spontaneous rupture of an asymptomatic parathyroid adenoma in a 56-year-old Caucasian woman who presented with a painful mass in the right side of her neck.ConclusionBased on this case report and similar cases reported in the medical literature, a diagnosis of extracapsular parathyroid hemorrhage should be considered when a non-traumatic sudden neck swelling coexists with hypercalcemia and regional ecchymosis.
Highlights
The spontaneous rupture of a parathyroid adenoma accompanied by extracapsular hemorrhage is a rare, potentially fatal, condition and is a cervicomediastinal surgical emergency.Case presentation: This report describes an atypical two-step spontaneous rupture of an asymptomatic parathyroid adenoma in a 56-year-old Caucasian woman who presented with a painful mass in the right side of her neck
Based on this case report and similar cases reported in the medical literature, a diagnosis of extracapsular parathyroid hemorrhage should be considered when a non-traumatic sudden neck swelling coexists with hypercalcemia and regional ecchymosis
27 cases have been reported in the literature and none of them describe a two-step clinical picture of bleeding from the parathyroid gland (Table 1) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]
Summary
Hypercalcemia is the most common clinical sign of a parathyroid adenoma [1]. Hemorrhagic infarction may occur both in a parathyroid adenoma and in hyperplastic parathyroid glands, whereas extracapsular hemorrhage due to hyperplasia, adenoma, or cancer is an uncommon but threatening occurrence, resulting in a cervicomediastinal hematoma and is often associated with severe blood calcium imbalance. Patients usually present with a palpable lateral neck mass with signs of ecchymosis, appearing slowly 24 to 48 hours after the sudden onset of neck discomfort, dysphagia, dyspnea, or hoarseness [19,24]. Such an emergency requires immediate surgical treatment and the prognosis depends on the extent and location of the hematoma. During the CT procedure, the patient suffered from severe respiratory distress with dyspnea and she was immediately referred for surgical treatment, where an ovoid, hemorrhagic mass (4.0 × 2.4 × 1.3 cm, weight 8.1 g) was revealed posterior to the right thyroid lobe. A 9-month follow-up including clinical evaluation, serology and US, revealed no clinical abnormalities
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