Hoang Phan Hiep, Thanh Do Cong, Ngoc Tran Luong, Giang Nguyen Son, Ngoc Tran Diep, Tien Nguyen Son, Dinh Le Tuan
Department of High-Tech Medical Treatment, Vietnam National Endocrinology Hospital, Hanoi Vietnam.
Department of Rheumatology and Endocrinology, Vietnam Military Hospital 103, Military Medical University, Hanoi, Vietnam.
Clin Med Insights Case Rep. 2023 Aug 3;16:11795476231190538. doi: 10.1177/11795476231190538. eCollection 2023.
The clinical picture of parathyroid tumors is mainly related to hypercalcemia such as kidney stones and bone and muscle pain. However, spontaneous cervical hemorrhage due to parathyroidoma bleeding is rare with clinical manifestations of the painful swelling and bruising of the neck accompanied by dysphagia and dyspnea.
We report a case of a 71-year-old female patient who presented with acute cervical swelling and extensive bleeding spreading from the neck to the abdomen and 2 flanks. Investigation of patients revealed increased parathyroid hormone levels and hypercalcemia. The neck ultrasound showed the thyroid nodules in 2 lobes, and goiter plongeant on the right. Computed tomography scan images showed a hematoma spreading from the right side of the neck to the mediastinum.
The patient required emergency surgery due to dyspnea and hemodynamic instability. The preoperative diagnosis was cervical bleeding with the likely cause being thyroid nodule rupture. However, during the surgery, the bleeding source was determined to be the right parathyroid tumor located deeply below the superior mediastinum. The patient's histopathological result of the tumor is parathyroid adenocarcinoma.
From our experience, the hemorrhage from parathyroid tumor should be considered as a cause of acute neck bleeding when no history of trauma or surgery is identified. Post-surgery histopathological analyses of the tumor are very important to detect parathyroid adenocarcinoma.
甲状旁腺肿瘤的临床表现主要与高钙血症相关，如肾结石以及骨骼和肌肉疼痛。然而，甲状旁腺瘤出血导致的自发性颈部出血较为罕见，其临床表现为颈部疼痛性肿胀和瘀斑，并伴有吞咽困难和呼吸困难。
我们报告一例71岁女性患者，其出现急性颈部肿胀以及从颈部蔓延至腹部和双侧胁腹的广泛出血。对患者的检查显示甲状旁腺激素水平升高和高钙血症。颈部超声显示双侧叶有甲状腺结节，右侧有坠入性甲状腺肿。计算机断层扫描图像显示血肿从颈部右侧蔓延至纵隔。
由于呼吸困难和血流动力学不稳定，患者需要紧急手术。术前诊断为颈部出血，可能原因是甲状腺结节破裂。然而，手术过程中确定出血源是位于上纵隔深部的右侧甲状旁腺肿瘤。患者肿瘤的组织病理学结果为甲状旁腺癌。
根据我们的经验，在未发现创伤或手术史的情况下，应考虑甲状旁腺肿瘤出血是急性颈部出血的一个原因。术后对肿瘤进行组织病理学分析对于检测甲状旁腺癌非常重要。
