Sunny S A, Singh A, Adhikary A B
Dr Mohammad Samir Azam Sunny, Medical Officer, Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2019 Jan;28(1):245-249.
Ectopic parathyroid are most frequently found in the anterior mediastinum, in association with the thymus or the thyroid gland. Ectopic parathyroid glands are a major cause of persistent and recurrent Hyperparathyroidism. We report a case of 65-year-old female was referred from Surgical Endocrine department to the department of Cardiac Surgery on 20 September, 2017 in Bangabandhu Sheikh Mujib Medical University with parathyroid crisis due to an ectopic mediastinal parathyroid adenoma with her serum calcium and PTH markedly increased in short time. Computed tomography of the chest and lower neck showed an ovoid soft tissue density area measuring about 25×20×15mm in the anterior mediastinum. Technetium-99m-sestamibi (MIBI) scintigraphy scan showed positive and detected localized parathyroid adenoma/hyperplasia in superior mediastinum. Ectopic parathyroid adenoma resection was performed via median sternotomy approach. But after 4 hours patient developed the color change of the left arm due to acute left upper limb ischemia of unknown cause for which the patient was rushed to operation theatre suspecting it to be embolic occlusion and managed by both surgical and medical therapy.
异位甲状旁腺最常见于前纵隔，与胸腺或甲状腺相关。异位甲状旁腺是持续性和复发性甲状旁腺功能亢进的主要原因。我们报告一例65岁女性，于2017年9月20日从外科内分泌科转诊至达卡班达胡·谢赫·穆吉布医科大学心脏外科，因异位纵隔甲状旁腺腺瘤导致甲状旁腺危象，其血清钙和甲状旁腺激素在短时间内显著升高。胸部和下颈部计算机断层扫描显示前纵隔有一个椭圆形软组织密度区域，大小约为25×20×15mm。锝-99m-甲氧基异丁基异腈（MIBI）闪烁扫描显示阳性，并在上纵隔检测到局限性甲状旁腺腺瘤/增生。通过正中胸骨切开术进行异位甲状旁腺腺瘤切除术。但术后4小时，患者因不明原因的急性左上肢缺血出现左臂颜色改变，患者被紧急送往手术室，怀疑是栓塞性阻塞，并接受了手术和药物治疗。
