Spontaneous rupture of the parathyroid adenoma with formation cervico-retrosternal cyst and massive hematoma: a case report
https://doi.org/10.14341/serg12708
Abstract
In this case report the authors inform about cervico-retrosternal cyst of the parathyroid gland, which develops as a result of spontaneous rupture of the adenoma and the formation of a hematoma with the development of neck compression syndrome. The patient was admitted to the clinic, a week after the onset of the disease, with complaints of dyspnea at rest, stridor breathing, weakness and mass formation of the right lateral region of the neck. There is no history of injuries, pathological fractures or invasive manipulations on the neck, indications of pathology of the thyroid or parathyroid glands. According to multispiral computed tomography, a volumetric fluid formation of the neck and upper mediastinum 63×57 mm in size with compression and narrowing of the trachea up to 5 mm was found. To clarify whether the formation belongs to the thyroid gland or the thyroid gland, a transcutaneous puncture was performed. The level of parathyroid hormone in the liquid is more than 2500 mg / ml, and in the blood — 304.9 pg / ml — parathyroid cyst. Using an increase in compression syndrome, removal of a cyst in a block with adenoma of the right lower parathyroid gland with achievement of remission of primary hyperparathyroidism. This clinical observation shows a rare course of parathyroid adenoma with rupture and hematoma formation, which led to the development of neck compression syndrome.
About the Authors
E. A. Ilyicheva
Irkutsk Scientific Center of Surgery and Traumatology
Russian Federation
Russian Federation
Elena A. Ilyicheva, MD, PhD, Professor
G. A. Bersenev
Irkutsk Scientific Center of Surgery and Traumatology
Russian Federation
Russian Federation
Gleb A. Bersenev, postgraduate student
1 str. Borcov Revolyucii, 664003 Irkutsk
E. G. Grigoryev
Irkutsk Scientific Center of Surgery and Traumatology; Irkutsk State Medical University
Russian Federation
Russian Federation
Eugene G. Grigoryev, MD, PhD, Professor
References
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Supplementary files
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1. Fig. 1. Computed tomography of the neck. 1a — frontal view, 1b — axial view: arrows indicate anatomical structures: 1 — cystic formation; 2 — the lumen of the trachea; 3 — common carotid artery; 4 — internal jugular vein; 5,7 — aortic arch; 6 — subclavian artery. | |
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2. Fig. 2. Computed tomography of the neck with angiography after transcutaneous aspiration cyst puncture.т2a — frontal projection; 2b — axial view; 2c — sagittal projection: arrows indicate anatomical structures: 1 — parathyroid cyst; 2 — left common carotid artery; 3 — the lumen of the trachea; 4 — left subclavian artery; 5 — brachiocephalic trunk; 6 — aortic arch. | |
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3. Fig. 3. Intraoperative photos. 3a — mobilization parathyroid cyst; 3b — after mobilization; 3c — after removal of the macro-preparation. Arrows indicate anatomical structures: 1 — parathyroid cyst; 2 — the right lobe of the thyroid gland; 3 — right neurovascular bundle of the neck; 4 — hematoma; 5 — right recurrent laryngeal nerve. | |
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4. Fig. 4. Postoperative macro specimens. A cyst removed in a single block with the lower right parathyroid gland (indicated by an arrow). | |
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5. Fig. 5. Microphotos of the surgical material. Hematoxylin-eosinom staining. Magnification 10x0.25. Arrows indicate histological structures. 5a — fragment of tissue of the right lower parathyroid gland: 1 — fragment of unchanged parathyroid tissue; 2 — a fragment of an adenoma from active main cells; 3 — site of hemorrhage and hematoma. 5b — tissue fragment of the right lower parathyroid gland at the border with the cyst wall: 1 — dense fibrous wall of the parathyroid cyst; 2 — capsule of adenoma of the right lower parathyroid gland; 3 — tissue of the right lower parathyroid adenoma from active main cells. | |
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Review
For citations:
Ilyicheva E.A., Bersenev G.A., Grigoryev E.G. Spontaneous rupture of the parathyroid adenoma with formation cervico-retrosternal cyst and massive hematoma: a case report. Endocrine Surgery. 2021;15(2):27-33. (In Russ.) https://doi.org/10.14341/serg12708
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