title: Parathyroid adenoma causing spontaneous cervical hematoma: two case reports.
abstract: BACKGROUND
  Although spontaneous rupture of a cervical parathyroid adenoma with extracapsular hemorrhage is rare, it may cause cervical and mediastinal hematoma, leading to potentially fatal consequences.
  
  
  METHODS
  The first case was a 76-year-old Asian female who presented with pharyngeal discomfort and anterior chest ecchymosis. Endoscopic investigation showed submucosal hemorrhage in the pharynx and larynx. The second case was a 62-year-old Asian male who presented with anterior chest ecchymosis and suspected of a ruptured blood vessel. Both cases were diagnosed parathyroid adenoma with extracapsular bleeding by hypercalcemia, high levels of intact parathyroid hormone and presence of a nodule behind the thyroid. Both cases were treated with excision of tumor 7 months after initial presentation. After surgery, serum calcium and parathyroid hormone levels had decreased to normal level in both cases.
  
  
  CONCLUSIONS
  Extracapsular bleeding of a parathyroid adenoma should be considered in the differential diagnosis of non-traumatic neck hematoma.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan. takami@kobe-u.ac.jp.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Shinomiya
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan. naokies@med.kobe-u.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Otsuki
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan. esca0de@yahoo.co.jp.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Takahara
authors.affiliation: Department of Otorhinolaryngology, Kakogawa West City Hospital, Kakogawa, Japan. ryasui_ksb@knc.kakogawa.or.jp.
authors.forename: Rie
authors.initials: R
authors.lastname: Yasui
authors.affiliation: Department of Otolaryngology, Nishi-Kobe Medical Center, Kobe, Japan. sawada_naoki@hotmail.com.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawada
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan. komapapa@med.kobe-u.ac.jp.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan. gneapig@med.kobe-u.ac.jp.
authors.forename: Hisami
authors.initials: H
authors.lastname: Fujio
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan. ah0i1tg5em3a8nt47@gmail.com.
authors.forename: Hajime
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan. nibu@med.kobe-u.ac.jp.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Nibu
mesh_terms: D000236:Adenoma / Q000150:complications*; D000368:Aged; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply*; D010282:Parathyroid Neoplasms / Q000150:complications*