Hotes L S, Barzilay J, Cloud L P, Rolla A R
Department of Medicine, Brockton Hospital, Massachusetts.
Am J Med Sci. 1989 May;297(5):331-3. doi: 10.1097/00000441-198905000-00012.
A patient with long-standing, asymptomatic, primary hyperparathyroidism developed pain in the anterior neck area, with cough, dysphagia and increasing shortness of breath. This led to respiratory insufficiency, which required endotracheal intubation and respirator assistance. During the ensuing hours the patient developed an area of ecchymosis on the anterior chest. Chest x-ray showed widening of the superior mediastinum, and CT scan showed a large mass with a fluid level. Surgery revealed a large hematoma originating from a mediastinal parathyroid adenoma with a hemorrhagic infarct. Serum calcium, previously elevated, decreased to normal with the onset of neck pain, and the patient remains normocalcemic. Previous reported cases of this rare complication of parathyroid adenomas are reviewed. Hemorrhagic infarct of a parathyroid adenoma may present with a rapidly enlarging mediastinal mass, and/or hypercalcemic crisis. Surgical removal of the infarcted adenoma can return the serum calcium to normal.
一名患有长期无症状原发性甲状旁腺功能亢进的患者出现前颈部区域疼痛，并伴有咳嗽、吞咽困难和呼吸急促加重。这导致了呼吸功能不全，需要进行气管插管和呼吸机辅助。在随后的几个小时里，患者前胸出现了一片瘀斑区域。胸部X线显示上纵隔增宽，CT扫描显示一个有液平面的大肿块。手术发现一个源于纵隔甲状旁腺腺瘤并伴有出血性梗死的大血肿。血清钙此前一直升高，随着颈部疼痛的出现降至正常，患者目前血钙正常。对先前报道的甲状旁腺腺瘤这种罕见并发症的病例进行了回顾。甲状旁腺腺瘤的出血性梗死可能表现为纵隔肿块迅速增大和/或高钙血症危象。手术切除梗死的腺瘤可使血清钙恢复正常。
