SHM Converge Scientific Abstract ePoster Gallery-Intrathymic Parathyroid Adenoma Manifested by Hemorrhagic Complications

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This case describes a rare intrathymic parathyroid adenoma presenting with hemorrhagic complications in a 32-year-old woman. She arrived with five weeks of pleuritic, positional chest pain radiating to the left shoulder and back, mild shortness of breath, and a history of recent chest bruising. Initial evaluation showed normal vital signs, negative troponins, normal sinus rhythm on EKG, and elevated calcium at 11.1 mg/dL.<br /><br />CT angiography revealed a moderate-to-large anterior mediastinal hematoma with active contrast extravasation, a suspected left anterior mediastinal mass, bilateral hemorrhagic pleural effusions, and a small pericardial effusion. She was initially managed conservatively in the ICU with a chest tube because she remained hemodynamically stable. Subsequent MRI confirmed a 3.4 cm anterior mediastinal mass, and staging studies showed no metastatic disease. Tumor markers were normal.<br /><br />Two days later, her hemoglobin fell from 13 g/dL to 7.3 g/dL with fatigue and tachycardia, prompting median sternotomy and resection of the mass. Operative findings showed a large hematoma extending through mediastinal fat and thymic tissue without invasion of surrounding structures. Pathology confirmed an intrathymic parathyroid adenoma associated with a large organizing hematoma and fibrosis. Postoperatively, calcium, parathyroid hormone, and phosphorus normalized, and she was discharged in stable condition after chest tube removal.<br /><br />The report highlights that while most parathyroid adenomas occur in the neck, ectopic adenomas can occur in the thymus due to embryologic migration abnormalities. Mediastinal hemorrhage is a rare presentation and can make diagnosis and surgical management difficult.

Asset Subtitle

Ishwarya Satyavarapu

Meta Tag

Author List Andres Reyes, Ishwarya Satyavarapu, Osama Odeh

Category Clinical Vignettes

Concept Intrathymic Parathyroid Adenoma

Concept Primary Hyperparathyroidism

Concept Hypercalcemia

Concept Parathyroid Hormone

Concept Surgical Resection

Distinguished Non-Finalist

Presenter Organization Houston Methodist - The Woodlands

Presenting Author Ishwarya Satyavarapu

Track Adult

Keywords

intrathymic parathyroid adenoma

mediastinal hematoma

hemorrhagic pleural effusion

anterior mediastinal mass

hypercalcemia

median sternotomy

ectopic parathyroid tissue

thymic tumor

parathyroid hormone

chest pain

Intrathymic Parathyroid Adenoma

Primary Hyperparathyroidism

Hypercalcemia

Parathyroid Hormone

Surgical Resection