Intra-thoracic Parathyroid Adenomatosis: A Case Report
A 37-year-old female who had undergone a total parathyroidectomy 4 months previously for a parathyroid adenoma presented in our clinic with high serum calcium (10.3 mg/dL) and high intact parathyroid hormone levels (iPTH; 1,378 pg/mL). A technetium-99m sestamibi scan was performed to determine whether there was any remnant parathyroid tissue or whether there was a satellite adenoma. A focal nodule with increased uptake of technetium was detected in the left lower paratracheal area and suspected to be an ectopic parathyroid adenoma (). The mass was located on the left side of the pulmonary trunk, and we decided to perform a surgical biopsy. Preoperatively, we performed a chest computed tomography (CT) scan to localize the mass more accurately without enhancement because of her impaired renal function. She had been diagnosed with chronic rejection following transplantation of both kidneys, and was on hemodialysis. The mass was located between the aortic arch and the pulmonary trunk, apparently adhering to the inferior side of the aortic arch in the CT scan ().\nBecause the nodule was located deep inside the lower paratracheal area and was thought to adhere to the aortic arch, and a recurrent laryngeal nerve was nearby, excision through a posterolateral thoracotomy was planned. After opening the left 5th intercostal space with one lung ventilation, the mediastinal pleura was opened in the aorto-pulmonary window. A firm and brownish mass about 2 cm in diameter was seen to be in contact with the lesser curvature of the aortic arch. During the operation, the recurrent laryngeal nerve was saved by snaring. The mass was carefully dissected free from the aorta, and it was sent for pathological examination. A frozen biopsy revealed a parathyromatosis. A 24 Fr chest tube was inserted and the wound was closed layer by layer. She was then transferred to a general ward with tolerable vital signs.\nThe immediately postoperative serum iPTH level was 32.9 pg/mL, and it had decreased to 5.1 pg/mL by the time of discharge. The postoperative course was uneventful and the patient was discharged on postoperative day 6 without any problems. The last follow-up took place 4 months after the excision, and the patient had been doing well, without any complications.