Images in Clinical Medicine
Extracapsular Hemorrhage from a Parathyroid Adenoma
N Engl J Med 2008; 359:1155September 11, 2008
- Article
A healthy 34-year-old woman presented with an acute, painful swelling and bluish discoloration of the anterior neck with no associated trauma. She reported having fatigue, anorexia, and depression during the past few weeks. On examination, she had extensive ecchymosis of the anterior neck and chest (Panel A). Laryngoscopy showed a hematoma at the level of the arytenoid and epiglottis. Laboratory tests revealed a serum calcium level of 5.8 mmol per liter (23.1 mg per deciliter) (normal range, 2.2 to 2.6 mmol per liter [8.8 to 10.6 mg per deciliter]), a serum phosphate level of 0.7 mmol per liter (2.2 mg per deciliter) (normal range, 0.8 to 1.4 mmol per liter [2.5 to 4.3 mg per deciliter]), and a serum parathyroid hormone level of 195 pmol per liter (normal range, 1.4 to 7.3). A computed tomographic scan of the neck (Panel B) showed a hematoma at the level of the upper right thyroid cartilage (arrows) which was consistent with an extracapsular hemorrhage from a parathyroid adenoma. Since the hypercalcemia did not respond to intravenous rehydration, forced diuresis, and pamidronate, surgery was performed and an enlarged parathyroid adenoma was removed. The patient made a full recovery with normalization of her calcium, phosphate, and parathyroid hormone levels within 5 days after surgery.
M. Carola Zillikens, M.D.
Anke Wijbenga, M.D., Ph.D.
Erasmus Medical Center, 3000 CA Rotterdam, the Netherlands
m.c. zillikens@erasmusmc. nl
