Difficult airway due to cervical haemorrhage caused by spontaneous rupture of a parathyroid adenoma: A case report

BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction.Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.

Reports of one case of double parathyroid adenomas and one case of ectopic mediastinal parathyroid adenoma

It is difficult to diagnose primary hyperparathyroidism because of its variable symptoms and limited understanding of doctors.We reported one case of double parathyroid adenomas and one case of ectopic mediastinal parathyroid adenoma.Serum calcium and parathyroid hormone(PTH) was screened.99mTc sestamibi scintigraphy single photon emission computed tomography(SPECT) had been taken to find the parathyroid adenoma.Combined with ultrasonography or CT,we localized parathyroid adenomas precisely.After the operation,both patients developed hypocalcaemia,they were treated medically,and followed up.

Parathyroid Adenoma Presenting as a Giant Cystic Neck Mass

We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, cystic neck masses in adults. A 72 year old female presented to a tertiary academic medical center with a complicated past medical history and was found to have an asymptomatic central neck mass which measured 10.5 × 7.7 × 4.1 cm on ultrasound and extended from the retropharyngeal space with mass effect on the hypopharynx, esophagus, trachea, and right carotid space structures as well as the superior mediastinum. She had elevated calcium and parathyroid hormone (PTH) levels. She underwent surgical excision of this mass and had an uneventful postoperative period. Large cystic neck masses generate a wide differential diagnosis. In adults, it is important to consider the rare possibility of parathyroid adenoma, especially in patients who may not be able to communicate vague symptoms of hypercalcemia. This particular parathyroid adenoma is several orders of magnitude larger than an average parathyroid adenoma and its massive size served as a distraction for the proper diagnosis as large, cystic neck masses in adults are to be considered cancer until proven otherwise.

Parathyroid adenoma combined with a rib tumor as the primary disease: A case report

BACKGROUND Parathyroid adenoma is a benign parathyroid tumor,with serum parathyroid hormone and calcium ion concentrations as the typical basis for diagnosis.Its clinical manifestations are complex and changeable;thus it is easily missed or misdiagnosed.Approximately 85%of patients with parathyroid adenoma develop primary hyperparathyroidism,and abnormalities in bones,kidneys and other organs can occur.Brown tumors are rare.CASE SUMMARY We report a rare case of fibrocystic osteitis associated with a parathyroid adenoma,which was discovered by chance due to a rib tumor.Abnormally elevated serum parathyroid hormone and calcium ion were found before surgery.We suspected primary hyperparathyroidism,and color Doppler ultrasound suggested the presence of a thyroid mass.With informed consent by the patient and her family,we first removed the rib tumor,and one week later,resection of the parathyroid adenoma and thyroid mass was performed on both sides,and the patient recovered well after surgery.CONCLUSION In the case of parathyroid adenoma combined with brown tumor,the bone cyst will gradually decrease in size with time without treatment.If not,surgery should be performed as soon as possible.

Synchronous parathyroid adenoma, papillary thyroid carcinoma and thyroid adenoma in pregnancy: A case report

BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy.She was diagnosed with parathyroidoma,papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically.Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy.The healthy infant was delivered at the 40th week of pregnancy.The mother had no evidence of recurrence over three years of follow-up.CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.

Analysis of the successful clinical treatment of 140 patients with parathyroid adenoma:A retrospective study

BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.

Comparison of the Efficacy of Ultrasound-Guided Microwave Ablation of Parathyroid Adenoma with Surgical Procedures

Objective: To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. Methods: The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. Results: The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Conclusion: Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.

Twin pregnancy with triple parathyroid adenoma:A case report and review of literature

Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.

Giant Cystic and Mediastinal Parathyroid Adenoma with Non-Uptake in Scintigraphy

Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound and scintigraphy combination. Difficulties can appear. If the gland is not located in a cervical position and has no uptake in scintigraphy but there is high suspition of an adenoma causing the PHPT, some extra tests should be considered. Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy. We report the CT scan and the magnetic resonance imaging (MRI) images that show the tumour. It was surgically resected by a cervical approach. After the excision, the patient recovered normal levels of Calcium and Parathormone (PTH). Conclusion: We review literature about cystic and mediastinal adenomas and diagnostic methods when the standard ones do not give an accurate localization diagnosis.

Large parathyroid adenoma presenting as a femoral fracture in a young male

Parathyroid adenoma classically presents symptoms of hypercalcaemia. Here, we present a case of a rare presentation of a parathyroid adenoma in a young male patient with a pathological fracture.

Intrathymic Parathyroid Adenoma

Introduction: Mediastinal parathyroid adenoma localization is a rare entity. We report a case of excision by manubriotomy of intrathymic parathyroid adenoma detected by Computed Tomography scan of the chest and neck and confirmed by Technetium-99 m-sestamibi scan (99 mTc-MIBI). Case Presentation: A 68 years old woman with history of hypercalcaemia, PTH elevation and operation for pathological fracture of the left femur 7 days before was presented to our service. The patient underwent manubriotomy and the adenoma was found within the right lobe of the thymus gland. Conclusion: The Technetium-99 m-sestamibi scan evaluation can be useful in the preoperative localization of ectopic parathyroid adenomas. The surgical approach by manubriotomy is privileged when the ectopic adenoma is in the upper part of anterior mediastinum.

Recurrent acute pancreatitis as an initial presentation of primary hyperparathyroidism:A case report

BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.

Surgery for Ectopic Parathyroid Adenoma in Lower Part of Superior Mediastinum through a Transcervical Incision

INTRODUCTION Ectopically located hyperfunctioning parathyroid gland（s） are responsible for approximately 6-16% ofhyperparathyroidism cases, in which about 6% can be ascribed to ectopic growth in the mediastinal site. Treatment ofectopic adenomas usually requires resection. There are various techniques to resect ectopic parathyroid glands, which are mainly depended on the ectopic gland＇s location. However, choosing the correct type of treatment for cases can be difficult since there are no commonly accepted guidelines for treatment selection.

PRELIMINARY APPLICATION OF COLOR DOPPLER FLOW IMAGING IN THE LOCALIZATION OF PARATHYROID ADENOMAS

From December 1991 to April 1993, we performed color Doppler flow imaging (CDFI) in 11 patients with parathyroid adenoma, and all cases were confirmed by operation and pathology. In all the parathyroid adenomas,vessels were clearly revealed at the periphery of the upper pole and/or anterior periphery, where arterial signals were elicited. These arteries had branches into the adenomas and originated from inferior thyroid arteries on the same side in most cases. The internal flow signals were increased markedly as compared to normal thyroid, and high-velocity arterial signals were detected. Because of the thyroid' s rich blood supply and landmark peripheral vessels, CDFI can distinguish parathyroid foci from thyroid nodules, lymph nodes, and normal tissues and provide a sound basis for the diagnosis of small parathyroid foci.

Parathyroid carcinoma:Three case reports

BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the individual tumor and the degree of hypercalcemia.CASE SUMMARY The aim of this report is to summarize the diagnosis and treatment of three cases of PC and to review and conclude aspects regarding the three collected cases with reference to other relevant cases to explore the value of ultrasound in the diagnosis of PC.All three patients had hypercalcemia,consisting of a high serum calcium level and a high level of parathyroid hormone that was>2-fold(even>30-fold)of the normal upper limit.The ultrasonographic findings of the parathyroid gland showed that the glands were all>30 mm,and the internal echo was uneven.All patients underwent surgery.PC in three cases was confirmed by routine histopathology and immunohistochemistry.CONCLUSION As clinical signs and laboratory results are nonspecific,it is difficult to diagnose PC preoperatively,so imaging examinations are often needed.

Multi-modality parathyroid imaging:A shifting paradigm

The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration.The common causes include solitary parathyroid adenoma,multiple parathyroid adenomas,parathyroid hyperplasia and parathyroid carcinoma.It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging.The various imaging modalities available include high resolution ultrasound of the neck,nuclear imaging studies,four-dimensional computed tomography(4D CT)and magnetic resonance imaging.Contrast enhanced ultrasound is a novel technique which has been recently added to the armam-entarium to differentiate between parathyroid adenomas and its mimics.Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.

甲状旁腺癌与甲状旁腺腺瘤的超声鉴别诊断

目的:分析超声鉴别甲状旁腺癌和甲状旁腺腺瘤的价值。方法:回顾性分析2016年1月至2021年12月于郑州大学第一附属医院经手术切除明确诊断的甲状旁腺肿瘤患者的临床资料,其中甲状旁腺癌21例,腺瘤27例。比较两组的超声征象。结果:甲状旁腺癌组男性患者比例高于腺瘤组,右下病变占比低于腺瘤组,超声回声为囊实性、血流为3级、有钙化的患者比例高于腺瘤组(P<0.05)。超声对甲状旁腺癌和腺瘤鉴别诊断的敏感度为85.71%,特异度为74.07%,约登指数为0.60。结论:超声检查对甲状旁腺癌及腺瘤具有一定的鉴别诊断价值。

超声影像组学评分联合常规超声图像特征鉴别诊断甲状旁腺腺瘤与甲状旁腺增生的临床价值

目的探讨超声影像组学评分(RS)联合常规超声图像特征鉴别诊断甲状旁腺腺瘤(PA)与甲状旁腺增生(PH)的临床应用价值。方法选取在我院行手术治疗的甲状旁腺功能亢进症患者133例(181个病灶),其中PA 66例(67个病灶),PH 67例(114个病灶),所有病灶按7∶3的比例随机分为训练集(126个病灶)和验证集(55个病灶),术前均行常规超声检查,基于灰阶超声图像勾画感兴趣区并提取影像组学特征。采用最小绝对收缩和选择算子(LASSO)回归筛选特征并构建影像组学模型,计算每个病灶的RS;采用多因素Logistic回归分析筛选差异有统计学意义的常规超声图像特征并构建常规超声模型,进一步构建基于RS联合常规超声图像特征的列线图模型。绘制受试者工作特征(ROC)曲线分析各模型对PA与PH的鉴别诊断效能;绘制校准曲线评估影像组学模型和列线图模型的校准度。结果基于LASSO回归筛选出8个影像组学特征用于构建影像组学模型,训练集中PA和PH的RS分别为(0.64±0.86)分、(-0.17±0.63)分;验证集中PA和PH的RS分别为(0.59±0.74)分、(-0.08±0.65)分,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,病灶最大径、外周线状高回声和极性供支血管征均为鉴别PA与PH的独立影响因素(均P<0.05),基于上述3个独立影响因素构建常规超声模型。在训练集和验证集中,影像组学模型鉴别诊断PA与PH的曲线下面积(AUC)分别为0.764和0.750,常规超声模型的AUC分别为0.812和0.838,列线图模型的AUC分别为0.825和0.856;列线图模型的AUC均高于影像组学模型,差异均有统计学意义(均P<0.05)。校准曲线显示,影像组学模型和列线图模型的校准度均较高,与实际结果的一致性均较好。结论RS联合常规超声图像特征能准确鉴别诊断PA与PH,具有较好的临床应用价值。

Acute necrotizing pancreatitis as fi rst manifestation of primary hyperparathyroidism

We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very uncommon.The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been proposed.It is important to treat the provoking factor.Therefore,the cause of hypercalcemia should be identif ied early.Surgical resection of the parathyroid adenoma is the ultimate therapy.

5例甲状旁腺腺瘤诊治分析

目的 分析5例甲状旁腺腺瘤(PA)患者的疾病特征,以提高临床对该病的诊治能力。方法 回顾性分析2021年1月至2022年7月明确诊断为PA的5例患者的一般资料、临床表现、实验室检查结果、影像学检查结果等。结果 5例患者均为女性,年龄28~67岁。入院时血钙水平[(2.92±0.18)mmol/L]均升高,血磷水平[(0.73±0.12)mmol/L]降低,甲状旁腺激素(PTH)水平[(161.30±68.00)pg/mL]明显升高,维生素D[(11.00±4.60)μg/L]缺乏。患者均为单发甲状旁腺病灶。4例患者于本院行PA切除术,术后PTH、血钙均正常。结论 中老年女性出现口干、乏力症状,合并多发泌尿系结石时,应注意检查血钙,进而检查是否存在PA;甲状旁腺发射型计算机断层扫描仪(ECT)检查为原发性甲状旁腺功能亢进症确诊的有效检查手段。