title: Thoracoscopic resection of a mediastinal intrathymic parathyroid adenoma.
abstract: Mediastinal parathyroid adenomas and thymomas can be resected via a transcervical approach, median sternotomy, or less invasive surgical option of video-assisted thoracoscopic resection and more recently by way of the da Vinci robot. We present a case of a mediastinal parathyroid adenoma in a 55-year-old female with primary hyperparathyroidism. MRI also confirmed a mediastinal adenoma localized on sestamibi scan. Significant laboratory values were elevated parathyroid hormone (PTH) of 171 pg/mL (normal range = 15 to 65 pg/mL) and calcium of 11.6 mg/dL (normal range = 8.5 to 10.5 mg/dL). Inability to hyperextend her neck due to cervical fusion made the transcervical approach unfavorable. To avoid a median sternotomy, we performed thoracoscopic resection of the adenoma via the left chest with the patient in a right lateral decubitus position. Three ports were placed; two in the anterior axillary line in the 4th and 6th intercostal spaces and one in the midaxillary line in the 5th intercostal space. Initial intraoperative PTH measurement was 192.9 pg/mL, and after adenoma removal the PTH level fell to 9 pg/mL. She was discharged home on postoperative day 1 without complications. At 3 months postprocedure, she remains asymptomatic with PTH and calcium levels within normal range. The 4 g, 2.4 cm intrathymic parathyroid adenoma had no evidence of malignancy. Thoracoscopic resection of an intrathymic parathyroid adenoma, a safe and less morbid alternative to median sternotomy, is an option when the transcervical approach is not viable.
authors.affiliation: Department of Surgery, St. Agnes Hospital, Baltimore, Maryland, USA.
authors.forename: Sylwia
authors.initials: S
authors.lastname: Karpinski
authors.forename: Armando
authors.initials: A
authors.lastname: Sardi
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008482:Mediastinum / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011877:Radionuclide Imaging / Q000379:methods; D017256:Technetium Tc 99m Sestamibi; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D017256:Technetium Tc 99m Sestamibi