Thoracoscopic Removal of an Ectopic Parathyroid Adenoma in the Aortopulmonary Window

Abstract

A 39-year-old woman with a history of nephrolithiasis was referred for evaluation of primary hyperparathyroidism. She had a serum calcium level of 11.1 mg/dL, a phosphorus level of 2.6 mg/dL, and an intact PTH level of 148 pg/mL. On cervical ultrasonography no pathology was detected in the parathyroid glands. However, ^99mTc-MIBI scintigraphy showed an abnormal up-take lesion in the middle mediastinum, and chest CT demonstrated a 1.5-cm, enhanced mass in the aortopulmonary window. The mass was removed during video-assisted thoracoscopic surgery (VATS), and on pathology, a parathyroid adenoma was diagnosed. The patient's serum calcium level and intact PTH level were normal on postoperative day 1. Although an ectopic parathyroid tumor in the mediastinum usually arises in the anterior or upper mediastinum, it can also rarely occur in the aortopulmonary window.