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).
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References
- 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.
- 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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