title: A case of thoracic hemorrhage due to ectopic parathyroid hyperplasia with chronic renal failure.
abstract: We report a case of secondary hyperparathyroidism in a 53-year-old man who had thoracic hemorrhage originating from an ectopic thymic parathyroid gland tumor. He was on long-term hemodialysis treatment and had persistent secondary hyperparathyroidism caused by 3 swollen parathyroid glands around the thyroid gland and a mediastinal ectopic parathyroid gland tumor. Parathyroidectomy and removal of the mediastinal tumor were planned. Preoperative chest x-ray and a computed tomographic scan obtained just before surgery showed left pleural effusion. Furthermore, diagnostic thoracentesis yielded hemorrhagic exudative fluid. Thoracoscopy confirmed the presence of a mediastinal tumor lesion that was bleeding into the thoracic cavity. The tumor was resected using thoracoscopic surgery, and ectopic thymic parathyroid gland hyperplasia associated with hemorrhage was pathologically diagnosed. A postoperative diagnostic chest computed tomographic scan and technetium 99m 2-methoxyisobutyl isonitrile scintigraphy showed successful removal of the ectopic parathyroid gland tumor. Subsequently, the secondary hyperparathyroidism could be clinically controlled by medical treatment, and total parathyroidectomy has been postponed indefinitely. We consider that hemorrhage from the ectopic parathyroid gland tumor resulted in thoracic bleeding. To our knowledge, this is the first case report of secondary hyperparathyroidism with thoracic hemorrhage originating from an ectopic mediastinal parathyroid gland.
authors.affiliation: Department of Medicine, Jichi Medical School, Minamikawachi-machi, Tochigi, Japan. tetsu-a@jichi.ac.jp
authors.forename: Tetsu
authors.initials: T
authors.lastname: Akimoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Saito
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Muto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nokubi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Numata
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ando
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sohara
authors.forename: Ken
authors.initials: K
authors.lastname: Saito
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusano
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002828:Choristoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology*; D006965:Hyperplasia; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008206:Lymphatic Diseases / Q000209:etiology*; D008297:Male; D008477:Mediastinal Diseases / Q000209:etiology*; D008875:Middle Aged; D010280:Parathyroid Glands; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D006435:Renal Dialysis / Q000009:adverse effects; D017256:Technetium Tc 99m Sestamibi; D020775:Thoracic Surgery, Video-Assisted; D013950:Thymus Gland / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi