A case of subcutaneous hemorrhage of the neck due to spontaneous bleeding in a parathyroid cyst

Abstract

A 78-year-old woman was referred to our hospital in May 2009 with swelling and subcutaneous hemorrhage of the neck that developed following neck discomfort and pharyngeal pain. Tests performed on admission revealed Hashimoto's disease and anemia. Serum calcium levels were normal. The patient complained of tenderness in the neck, and although CT showed a hematoma in the lower pole of the left lobe of the thyroid gland and contrast-enhanced CT revealed a mass with blood flow inside, no aneurysms were observed. Upper gastrointestinal endoscopy showed extramural compression and internal bleeding in the laryngopharynx. Since gallium scanning revealed no areas of increased uptake, the patient was diagnosed not with a tumor but with bleeding in a thyroid cyst. Following admission, the patient fasted, had her neck cooled, and was given hemostatic drugs. Surgery was performed one week after admission. Based on the findings of subcutaneous internal hemorrhage and a 40-mm cyst with internal bleeding that was not continuous with the lower pole of the thyroid gland, the patient was diagnosed as having bleeding in a cyst in the left inferior parathyroid gland, and the cyst was resected. Although the serum intact PTH was only slightly elevated preoperatively, intact PTH in the luminal aspirate was high (59,110 pg/ml). The histopathological diagnosis was parathyroid cyst with Hashimoto's disease. A patient who developed subcutaneous hemorrhage of the neck due to spontaneous bleeding in a parathyroid cyst is reported.