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Case Reports: Reminder of important clinical lesson
Resection of an elusive parathyroid adenoma in the aortopulmonary window
  1. Sophie Bondje1,
  2. Felicity Kaplan2,
  3. Fausto Palazzo3 and
  4. Tara Barwick4,5
  1. 1General Surgery, NHS Highland, Inverness, UK
  2. 2Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, UK
  3. 3Thyroid and Endocrine Surgery, Imperial College Healthcare NHS Trust, London, UK
  4. 4Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
  5. 5Department of Surgery and Cancer, Imperial College London, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Sophie Bondje; sophie.bondje{at}nhs.scot

Abstract

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia and is caused by a single parathyroid adenoma in the neck in 85% or more of patients. National Institute for Health and Care Excellence (NICE) guidelines published in May 2019 advise that preoperative imaging is offered prior to parathyroid surgery for PHPT if it will inform surgical approach. If imaging, typically a neck ultrasound and a second modality that may use ionising radiation, does not identify the adenoma or is discordant, it is advised that surgery is performed by a surgeon with expertise in the management of unlocalised parathyroid disease.The cure rate in such cases is over 96%. Occasionally, however, PHPT cure can be challenging.

A woman in her late 40s presented with bilateral renal calculi and was found to have PHPT. Following false positive imaging and three non-curative surgical procedures, removal of a supernumerary ectopic parathyroid adenoma in the aortopulmonary window via sternotomy achieved definitive cure.

  • Head and neck surgery
  • Cardiothoracic surgery
  • Endocrinology
  • Endocrine system

http://dx.doi.org/10.1136/bcr-2022-250380

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    Footnotes

    • Contributors SB wrote the manuscript. FK and FP were involved in the diagnosis, treatment and management of the case. They helped in reviewing the manuscript. TB was involved in diagnosis, management of the case, reviewing the manuscript and editing the images.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.