title: Video-assisted thoracoscopic surgery as a first-line treatment for mediastinal parathyroid adenomas: strategic value of imaging.
abstract: OBJECTIVE
  To present first-line thoracic surgery made possible by localization studies in three patients with ectopic parathyroid adenomas.
  
  
  METHODS
  Three patients with ectopic parathyroid tissue in the mediastinum were examined by ultrasound, technetium-99m sestamibi scintigraphy, computed tomography (CT), and venous catheterization with measurement of parathyroid hormone. Without previous cervical exploration, video-assisted thoracic surgery (VATS) was used in all cases to avoid the need for thoracic open surgical procedures.
  
  
  CONCLUSIONS
  The mediastinal parathyroid glands were all detected at scintigraphy, and CT and venous catheterization were helpful in anatomic and functioning characterization. All pathologic glands were successfully resected, with only one minor complication. VATS can safely remove a deep mediastinal parathyroid adenoma and avoid more aggressive open approaches. In an experienced referral center, systematic and sophisticated imaging studies may accurately identify and localize rare ectopic parathyroid adenomas, and avoid cervical surgery.
authors.affiliation: Department of Endocrinology, Cochin Hospital, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Amar
authors.forename: L
authors.initials: L
authors.lastname: Guignat
authors.forename: F
authors.initials: F
authors.lastname: Tissier
authors.forename: B
authors.initials: B
authors.lastname: Richard
authors.forename: O
authors.initials: O
authors.lastname: Vignaux
authors.forename: Y
authors.initials: Y
authors.lastname: Fulla
authors.forename: P
authors.initials: P
authors.lastname: Legmann
authors.forename: X
authors.initials: X
authors.lastname: Bertagna
authors.forename: P
authors.initials: P
authors.lastname: Bonnichon
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002828:Choristoma / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology; D008479:Mediastinal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed