A Case of Parathyroid Adenoma Presented with Descending Mediastinal Hematoma

Abstract

A 69-year-old woman presented to a hospital complaining of a sore throat and dysphagia. A chest CT scan showed a 50-mm diameter tumor in the superior portion of the mediastinum, and she was referred to our hospital. A chest CT scan revealed a superior mediastinal tumor with an enhancement effect and extravasation of contrast medium around the tumor. We made a diagnosis of penetration of the mediastinal tumor and performed emergency thoracoscopic surgery. The inspection of the thoracic cavity revealed that there was no tumor in the superior portion of the mediastinum but a hematoma covered with mediastinal pleura. The mediastinal hematoma extended to the neck. Since we could not identify the origin of the bleeding in the mediastinum following the removal of the hematoma, we carried out open-neck exploration. At surgery, we found a bleeding, enlarged parathyroid tumor on the dorsal aspect of the lower pole of the right thyroid lobe. Following the parathyroidectomy, the patient's postoperative course was uneventful, and she left the hospital on the 7th postoperative day. The pathological diagnosis was parathyroid adenoma. The parathyroid adenoma cells were also found in the hematoma specimen retrieved from the mediastinum. We present the rare parathyroid adenoma causing mediastinal hematoma with a literature review.