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Han YZ, Zhou Y, Peng Y, Zeng J, Zhao YQ, Gao XR, Zeng H, Guo XY, Li ZQ. Difficult airway due to cervical haemorrhage caused by spontaneous rupture of a parathyroid adenoma: A case report. World J Clin Cases 2023; 11:1217-1223. [PMID: 36874418 PMCID: PMC9979279 DOI: 10.12998/wjcc.v11.i5.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/23/2022] [Accepted: 01/16/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.
CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.
CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction. Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.
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Affiliation(s)
- Yong-Zheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
- Beijing Center, Quality Control and Improvement on Clinical Anesthesia, Beijing 100191, China
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
- Beijing Center, Quality Control and Improvement on Clinical Anesthesia, Beijing 100191, China
| | - Ying Peng
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jin Zeng
- Department of Otorhinolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Yu-Qing Zhao
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Xiao-Ru Gao
- Department of Anesthesiology, Haidian Maternal and Child Health Care Hospital, Beijing 100191, China
| | - Hong Zeng
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
- Beijing Center, Quality Control and Improvement on Clinical Anesthesia, Beijing 100191, China
| | - Xiang-Yang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
- Beijing Center, Quality Control and Improvement on Clinical Anesthesia, Beijing 100191, China
| | - Zheng-Qian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
- Beijing Center, Quality Control and Improvement on Clinical Anesthesia, Beijing 100191, China
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Familiari M, Di Santo D, Galli A, Danè G, Giordano L, Mellone R, Bussi M. Spontaneous extracapsular parathyroid adenoma hemorrhage: when surgery is required? Endocrine 2022; 75:575-582. [PMID: 34554413 DOI: 10.1007/s12020-021-02876-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Spontaneous bleeding is a rare but serious complication of parathyroid adenomas and few cases were reported in the literature. Clinical manifestations and treatment may vary but sometimes an immediate surgery is required. In other cases a conservative approach can be preferred based on clinical stability and patients' conditions. The purpose of this work is to describe our case and to carry out a review of the current literature on this topic. METHODS We reported a case of a parathyroid adenoma hemorrhage in an elderly patient describing its management. Moreover, a literature review of 57 cases was carried out, with the aim of collecting data about the most involved parathyroid gland and identifying the most correct management based on clinical manifestations and chosen treatments. RESULTS The patients had an age between 29 and 81 years (mean 56.9 ± 16.4 years). Forty-four patients were females (77.2%), whereas 12 were males (21.8%). Based on clinical severity, age, comorbidities and calcemic status, three possible scenarios were identified, each with a recommended management. CONCLUSIONS In parathyroid adenoma hemorrhages a careful clinical assessment is crucial to identify emergency conditions requiring immediate intubation, tracheostomy or neck exploration. Elderlies and comorbid patients have a higher risk of perioperative complications and indication for surgery should be evaluated case by case: whenever feasible, a conservative approach should be preferred in these subjects, especially in those with a stable course and without hypercalcemia-related symptoms.
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Affiliation(s)
- Marco Familiari
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy.
| | - Davide Di Santo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Andrea Galli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Giulia Danè
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Leone Giordano
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Renata Mellone
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
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MATARREDONA-QUILES S, MARTÍNEZ-RUÍZ DE APODACA P, GUALLART-DOMENECH F, DALMAU-GALOFRE J. Cervicomediastinic hematoma for spontaneous hemorrhage of adenoma of parathyroids: presentation of case and review of literature. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Liu Y, Li J, Liu H, Yang H, Qiao J, Wei T, Wang T, Yu Y. Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review. Front Endocrinol (Lausanne) 2021; 12:766234. [PMID: 34759892 PMCID: PMC8573193 DOI: 10.3389/fendo.2021.766234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hyperparathyroidism is a common cause of hypercalcemia; however, spontaneous remission after a hypercalcemic crisis caused by an intracystic hemorrhage of parathyroid adenomas is very rare. The question, then, is "What is the best treatment strategy for this type of case?" METHOD A 47-year-old male patient with primary hyperparathyroidism and a hypercalcemic crisis is reported. Hypercalcemia was spontaneously relieved thereafter. Postoperative paraffin pathology results indicated an intracystic hemorrhage of bilateral parathyroid adenomas. RESULTS After the case report, a literature review is also included to summarize the clinical features of this patient and to provide special reference for clinical diagnosis and treatment of similar cases. CONCLUSIONS The choice of surgical timing for such cases can be made based on the comprehensive consideration of clinical symptoms and changes in parathyroid function.
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Affiliation(s)
- Yaoxia Liu
- Department of Endocrinology and Metabolism, West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
- Department of Geriatrics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Geriatrics, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Jianwei Li
- Department of Endocrinology and Metabolism, West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
| | - Hui Liu
- Department of Endocrinology and Metabolism, West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
| | - Han Yang
- Department of Endocrinology and Metabolism, West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
| | - Jingtao Qiao
- Department of Endocrinology and Metabolism, West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
| | - Tao Wei
- Department of Thyroid Surgery, West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
| | - Tao Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- *Correspondence: Tao Wang, ; Yerong Yu,
| | - Yerong Yu
- Department of Endocrinology and Metabolism, West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Tao Wang, ; Yerong Yu,
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Nakatake N, Matsubayashi S, Hara T, Satoh S, Yamashita H. PRIMARY HYPERPARATHYROIDISM ACCOMPANIED BY RECOVERY OF PARATHYROID BLOOD FLOW THREE MONTHS AFTER SPONTANEOUS PARATHYROID HEMORRHAGE. AACE Clin Case Rep 2020; 6:e322-e325. [PMID: 33244494 DOI: 10.4158/accr-2020-0311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022] Open
Abstract
Objective The objective of this report was to describe an unusual case of emerging primary hyperparathyroidism (PHPT) accompanied by recovery of parathyroid blood flow 3 months after spontaneous parathyroid hemorrhage. Methods Neck images and laboratory tests including serum calcium and parathyroid hormone (PTH) were performed to evaluate parathyroid hemorrhage. Pathologic findings after parathyroidectomy are also presented. Results A 58-year-old woman developed acute onset of neck pain and swelling with ecchymosis. Computed tomography showed a right paratracheal hematoma-like lesion behind the thyroid. Ultrasound (US) of the neck revealed a round, hypoechoic nodule measuring 27 × 25 × 18 mm in the right lower thyroid pole without vascular flow. Blood tests showed a corrected calcium of 9.3 mg/dL (normal, 8.7 to 10.3 mg/dL), and intact PTH of 68 pg/mL (normal, 10 to 65 pg/mL). Intact PTH measurement in fine-needle aspirate of the lesion was 339 pg/mL, confirming parathyroid origin. Repeat US after 3 months showed a remarkable decrease in lesion size with significant blood flow. Blood biochemistry showed a corrected calcium of 10.9 mg/dL, and an intact PTH of 237 pg/mL. She eventually underwent parathyroidectomy, and pathologic examination revealed parathyroid adenoma with a tiny thrombus. Conclusion Spontaneous remission of PHPT after parathyroid hemorrhage has been known to occur sporadically, a phenomenon referred to as autoparathyroidectomy. Although spontaneous remission with permanent improvement of PHPT may be observed, PHPT can recur in the relative short term after parathyroid hemorrhage, and so follow-up blood biochemistry surveillance is necessary. Also, evaluating parathyroid blood flow using color Doppler US might be useful in verifying the recurrence of PHPT.
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