Navigating the Mediastinum: A VATS Solution for Ectopic Primary Hyperparathyroidism

Ectopic parathyroid adenomas in the anterior mediastinum are rare and present significant diagnostic and surgical challenges. This video shows the case of a 49-year-old male with a history of hypertension who presented with severe hypercalcemia (17.9 mg/dL) and acute kidney injury. Diagnostic evaluation, including 18F-choline positron emission tomography-computed tomography (PET-CT) (1), identified an ectopic parathyroid adenoma within the anterior mediastinum. The patient underwent a minimally invasive left-sided three-port video-assisted thoracoscopic surgery (VATS) (1, 4) for en bloc excision of the lesion along with surrounding thymic tissue. Successful resection was confirmed by a significant intraoperative parathyroid hormone (IOPTH) drop to 134 pg/mL and subsequent frozen section analysis. The postoperative course was uneventful with complete biochemical resolution. This case demonstrates that a left-sided VATS approach, guided by precise preoperative functional imaging and intraoperative PTH monitoring, offers a safe and highly effective alternative to traditional sternotomy for managing mediastinal ectopic parathyroid glands (2).

This video submission is from the 2026 CTSNet Instructional Video Competition. Stay tuned to CTSNet.org and the CTSNet YouTube channel in the coming weeks to watch all entries from the competition, including the winning videos.  

References

1. Manyalich-Blasi M, Domínguez-Garijo P, Saavedra-Pérez D, Sánchez-Izquierdo N, Casanueva Eliceiry S, Perissinotti A, Mora Porta M, de Hollanda A, Hanzu FA, López-Boado Serrat MA, Rull Ortuño AR, Ardid J, Vidal-Sicart S, Vidal Pérez Ò. Comparison of [18F]fluorocholine PET/CT with [99mTc]sestamibi and ultrasonography to detect parathyroid lesions in primary hyperparathyroidism: a prospective study. Gland Surg. 2022 Nov;11(11):1764-1771. doi: 10.21037/gs-22-198. PMID: 36518798; PMCID: PMC9742049.
2. Isaacs KE, Belete S, Miller BJ, Di Marco AN, Kirby S, Barwick T, Tolley NS, Anderson JR, Palazzo FF. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. BJS Open. 2019 Aug 19;3(6):743-749. doi: 10.1002/bjs5.50207. PMID: 31832580; PMCID: PMC6887896.

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