AUCTORES
Globalize your Research
Case Report
*Corresponding Author: ajaa El azzouzi. Department of Maxillofacial Surgery Hospital of Specialities; CHU Ibn Sina, Av. Abderrahim Bouabid, Rabat-Morocco.
Citation: Rajaa El Azzouzi, Othmane Bouanani, Sarra Benwadih, and Malik Boulaadas. (2023), Spontaneous Cervical Hematoma Revealing a Parathyroid Adenoma: A Case Report, J, Surgical Case Reports and Images 6(2); DOI:10.31579/2690-1897/145
Copyright: © 2023 Rajaa El azzouzi, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 02 February 2023 | Accepted: 06 February 2023 | Published: 08 February 2023
Keywords: adenoma; hematom; hypercalcemia; parathyroid; case report
Introduction:
Neck hematoma is a rare but potentially lifethreatening medical condition.
Although spontaneous rupture of a parathyroid adenoma with extracapsular hemorrhage is rare, it may cause cervical and mediastinal hematoma, leading to potentially fatal consequences, it should be considered when a non-traumatic sudden neck swelling coexists with hypercalcemia.
Case’s presentation:
This report describes an atypical spontaneous rupture of an asymptomatic parathyroid adenoma in a 42-year-old woman who presented to the emergency room after the acute installation of an unpainful voluminous swelling in the right side of her neck, after eliminating a vascular emergency. Hemodynamically stable, the patient was treated conservatively with a period of observation in hospital, 1 month follow-up imaging with CT confirmed a regression of the half volume of the hemorrhagic lesion and the likely source of hemorrhage as a parathyroid nodule with significant vascularity. The diagnosis was confirmed on histopathological analysis after elective surgical exploration of the neck 3 months of a benign parathyroid adenoma. The patient made a full recovery with immediate normalization of her biochemistry post-operatively.
Discussion:
Spontaneous rupture of a cervical parathyroid adenoma with extracapsular hemorrhage should be considered when a non-traumatic sudden neck swelling coexists with hypercalcemia. The most appropriate treatment, in the absence of dyspnea or dysphagia, we believe that it is preferable to intervene surgically in a delayed manner.
Conclusion:
A high suspicion index is needed, particularly in post-menopausal women, to reach a diagnosis and allow optimal management. Since bleeding may recur, we suggest an independent indication for definitive parathyroidectomy surgery.
Parathyroid adenoma can cause very rarely extracapsular bleeding. The clinical presentation can vary more widely depending upon the extent of hemorrhage. In 1934, Capps first reported a case of massive hemorrhage secondary to rupture of a parathyroid adenoma [1]. This report describes an atypical spontaneous rupture of an asymptomatic parathyroid adenoma in a 42-year-old woman who presented to the emergency room after the acute installation of an unpainful voluminous swelling in the right side of her neck with no others accompanied signs.
We report a case of 42-year-old woman, operated for a thyroid nodule 16 years ago presented to the emergency department with a sudden onset of unpainful voluminous swelling of the right side of her neck.
Figure 1: Front view showing the swelling of the right cervical region
No triggering factors such as trauma was mentioned. The patient did not report any compressive symptoms such as dyspnea or dysphagia, hoarseness nor any systemic symptoms of inflammation or infection. Clinical examination revealed in an afebrile patient with stable vital signs, the presence of a painless right basi-cervical mass of soft consistency, not beating, not expanding, without inflammatory signs or ecchymosis apparent beneath the skin, measuring 6.5 cm in long axis, the rest of the examination noted the absence of epistaxis, otorrhagia or gingivorrhagia.
As she was hemodynamically and respiratory stable, An initial computed tomography (CT) scan with injection was performed and showed the presence of a voluminous hemorrhagic lesion of the right carotid space, well limited spontaneously hyperdense, accentuated after injection of contrast product measuring 35*33*65 mm, pushing back the sterno-cleido mastoid muscle outside and arriving inside in contact with the hyoid bone, respecting the aero-digestive channel, which evokes a false aneurysm or a spontaneous cervical hematoma given the anamnestic data.
Figure 2: Axial and coronal CT scan showing the cervical hematoma
A vascular surgery opinion was requested, eliminating a vascular emergency. As she was hemodynamically stable, she was treated conservatively with a period of observation in hospital to monitor for signs of neck organ compression. 1 month follow-up imaging with CT and cervical ultrasound confirmed a regression of the half volume of the hemorrhagic lesion and the likely source of hemorrhage as a parathyroid nodule with significant vascularity.
The blood tests showed a corrected calcium of 2.70 (normal range 2.20–2.60) parathyroidhormone (PTH) 16.3 (normal range 1.60–6.90).
The diagnosis was confirmed on histopathological analysis after elective surgical exploration of the neck 3 months after her presentation. This revealed a benign parathyroid adenoma with evidence of acute and chronic bleeding. The patient made a full recovery with immediate normalization of her biochemistry post-operatively.
The first observation of an extracapsular hemorrhage of parathyroid origin was made by Capps in 1934 [1]. It concerned a 50-year-old woman who died suddenly in a context of dyspnea associated with a hematoma of the cervicothoracic region. The autopsy revealed that death was due to a suffocating hematoma secondary to a parathyroid hemorrhage. The development of respiratory complications from mediastinal extension or compressive symptoms is only described in a few cases, with the latter requiring emergency surgery [2,3].
A review of the literature shows that the majority of cases are seen in middle-aged females, as we reported in our case. Thus, spontaneous neck hematomas in post-menopausal women should prompt a PHPT workup.
In all described cases, hematoma is the first sign of hyperparathyroidism. Clinically, it manifests itself either as spontaneous neck pain or as dysphagia [4,5]. Dyspnea and dysphonia, which are rarer, are symptoms that should motivate an emergency surgical intervention according to Massard and Roma [6,7]. This atypical clinic often leads to diagnostic errors: in the pure cervical form, a thyroid hemorrhage is more often suspected. In the cervicomediastinal form, a ruptured thoracic aortic aneurysm is more likely to be suspected [7]. The patient's first priority is to be put in condition, followed by a radiological examination, mainly a CT scan and a cervical ultrasound, as well as biological tests, blood calcium and parathyroid hormone levels, to rule out differential diagnoses and to determine the etiology.
Simicic has defined a diagnostic triad suggestive of cervical hemorrhage of parathyroid origin which consists of cervical pain on swallowing, cervical and/or thoracic ecchymosis associated with hypercalcemia [8]. Studies have suggested that the rapid growth which eventually leads to an acute hemorrhage when demand outstrips the vascular supply.
As for the most appropriate treatment, in the absence of dyspnea or dysphagia, we believe that it is preferable to intervene surgically in a delayed manner.
This attitude, shared by most authors, has allowed us, in our experience, to carry out preoperative localizing examinations of the pathological gland, which then simplified the operative procedure. Moreover, the deferred emergency removal of the parathyroid gland makes it possible to intervene when the hematoma is in the process of resorption. Our experience shows that it is then easier to identify the parathyroid gland and the other anatomical structures including the recurrent laryngeal nerve [9].
Based on this case report and a few similar cases reported in the medical literature, a diagnosis of extracapsular parathyroid hemorrhage should be considered when a non-traumatic sudden neck swelling coexists with hypercalcemia. Conservative management is a suitable option for patients who remain hemodynamically stable but all should undergo a period of observation in hospital, and a definitive surgical exploration should be considered within at least a month of presentation to avoid the risks of recurrent bleeding.
Free and informed consent has been given by the patient.
The authors declare no conflicts of interest
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
