Spontaneous cervical haematoma caused by extracapsular haemorrhage from a parathyroid carcinoma presenting with acute onset neck swelling and dysphonia.

We present the case of a 69-year-old male patient who presented with progressive neck swelling causing symptoms of dysphonia and dysphagia. Flexible nasendoscopy revealed bruising of the right hemilarynx, hypopharynx and parapharyngeal mucosal consistent with a spontaneous cervical haematoma. After conservative management, the haematoma self-resolved and the source of the haematoma was thought to be a parathyroid adenoma. Surgical excision was completed, and histopathological assessment revealed a parathyroid carcinoma. Spontaneous cervical haematoma can progress to airway obstruction and the initial focus is to observe for any signs of progression and establish a secure airway if required. The subsequent challenge is to establish the origin of the haematoma and as in this case this can be a diagnostic challenge. This case highlights the diagnostic difficulties of spontaneous cervical haematoma, the importance of comprehensive investigation and the possibility of malignancy preoperatively, especially important when complete excision gives the best opportunity for cure.