75 yrs old woman present with post-myocardial infarction after 6 weeks with mild CHF. There was past H/O neck surgery for parathyroid adenoma 5 years ago, EKG shows slow atrial fibrillation. Serum Ca+2 13.0 mg/L and urinary Ca2+ is 300 mg/ 24 hr. On examination, there is small mass in the Para tracheal position behind the right clavicle. Appropriate management at this time is -: (A) Repeat neck surgery, (B) Treatment with technetium-99, (C) Observation and repeat serum ca in 2 months, (D) Ultrasound guided alcohol injection of the mass
Answer is D. This patient operated previously for parathyroid adenoma, is having recurrent hyperparathyroidism. In the setting of recent myocardial infarction, CHF and atrial fibrillation, any operation carries a high risk. Fuhermore, an operation on a previously operated neck is quite difficult. Alcohol ablation of the mass with ultrasound guidance or angiographic embolization is preferred in this setting.