Partial Sternotomy – Useful Approach for Mediastinal Ectopic Parathyroid Adenoma: Case Report and Literature Review

Abstract

Among failed parathyroidectomy causes an important role is played by glandular ectopies, encountered in approximately 20% of cases; in 2% of cases they are localized in the mediastinum. In this latter situation there is a need for a thoracic approach which may be either classical or minimally invasive. The minimally invasive surgery is appealing and the results surpass those of classical surgery. Nevertheless, there are situations in which minimally invasive surgery is inefficient, not indicated, or unaffordable, thus, the classical approach remains the only option for surgical treatment. Partial sternotomy could represent a good alternative to classical full sternotomy or thoracotomy. We present the case of a hemodialysed patient with secondary persistent hyperparathyroidism after two failed parathyroidectomies; localization studies identified an ectopic hyperfunctional mediastinal parathyroid gland which was excised through a partial sternotomy. To the best of our knowledge, this is the first case reported in Romanian literature which describes this kind of approach for a mediastinal ectopic parathyroid gland.