Spontaneous cervical haemorrhage of a parathyroid adenoma

[摘要] Haemorrhage of a parathyroid adenoma is a rare clinical presentation. This report describes a previously fit and well 54-yearold woman who presented with acute neck swelling and pain with an overlying ecchymosis. Admission laboratory testsrevealed a raised parathyroid hormone and hypercalcaemia. A computed tomography (CT) scan showed widespread anteriorcervical haemorrhage and a lesion at the inferior pole of the left thyroid gland. A working diagnosis of spontaneoushaemorrhage from a parathyroid adenoma was made. As she was haemodynamically stable, she was treated conservativelywith a period of observation in hospital to monitor for signs of neck organ compression. Follow-up imaging with CT,ultrasound and sestamibi confirmed the likely source of haemorrhage as a parathyroid nodule with significant vascularity.The diagnosis was confirmed on histopathological analysis after elective surgical exploration of the neck 6 months after herpresentation. This revealed a benign parathyroid adenoma with evidence of acute and chronic bleeding. The patient made afull recovery with immediate normalisation of her biochemistry post-operatively. Despite developing a hoarse voice in theimmediate post-operative period, this resolved completely within 1 month. This case report provides further evidence tosupport a minimal delay for elective surgery after conservative management to reduce the risks associated with recurrentbleeding.

[学科分类] 血液学

[关键词] Adult;Female;White;United Kingdom;Parathyroid;Endocrine-related cancer;PTH;Parathyroid adenoma;Hyperparathyroidism (primary);Haemorrhage;Cervical pain;Ecchymoses;Dysphonia;Hypercalcaemia;PTH;CT scan;Ultrasound scan;Sestamibi scan;Calcium (serum);Histopathology;Surgical biopsy;Radiology/Rheumatology;Surgery;Unique/unexpected symptoms or presentations of a disease;June;2015