title: Ectopic intravagal parathyroid adenoma.
abstract: BACKGROUND
  Intraneural parathyroid adenomas are rare, with only 9 cases of intravagal adenomas reported. All but one of the reported cases was found after multiple neck explorations. To the best of our knowledge, we report the first case of nonsupernumerary ectopic intravagal parathyroid identified at primary exploration.
  
  
  RESULTS
  A 17-year-old girl with primary hyperparathyroidism and nephrolithiasis was referred with a sestamibi scan reporting a left lower parathyroid adenoma. No eutopic parathyroid tissue was identified during full exploration of the left side of the neck. Exploration of the carotid sheath revealed a fusiform swelling of the vagus nerve at the level of the carotid bifurcation. Longitudinal incision of the vagal perineurium revealed a 7-mm parathyroid adenoma, which was enucleated. The patient recovered uneventfully, with normalization of serum calcium, parathyroid hormone (PTH), and normal vocal cord function.
  
  
  CONCLUSIONS
  We believe that this is the first reported case of nonsupernumerary intravagal parathyroid adenoma resected at initial exploration. The vagus nerve is a rare location for a parathyroid adenoma, but one that should be considered, even during primary exploration.
authors: Department of Surgery, University of Melbourne, Austin Health, Victoria, Australia.
authors: Jurstine
authors: J
authors: Daruwalla
authors: Department of Endocrinology, St. Vincent's Hospital, Victoria, Australia.
authors: Nirupa
authors: N
authors: Sachithanandan
authors: Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia.|Department of Anesthesia, Perioperative and Pain Medicine Unit, The University of Melbourne, Parkville, Australia.
authors: David
authors: D
authors: Andrews
authors: Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.|Epworth Freemasons Hospital, Victoria, Australia.|University of Melbourne Department of Surgery, Victoria, Australia.
authors: Julie A
authors: JA
authors: Miller
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D002828:Choristoma; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014630:Vagus Nerve
keywords: parathyroid adenoma; primary hyperparathyroidism; vagus nerve