Resection of parathyroid tumor in the aorticopulmonary window without prior neck exploration

Journal Article · Thu Dec 01 04:00:00 EST 1988 · Surgery; (United States)

OSTI ID:6516775

McHenry, C; Walsh, M; Jarosz, H; Henkin, R; Tope, J; Lawrence, A M; Paloyan, E

Of 522 patients with hyperparathyroidism operated on from 1973 to 1987 at our institution, there were seven (1.3%), each with an ectopic, hyperfunctioning mediastinal parathyroid adenoma, who required median sternotomy. In three of these seven patients, the tumor was located in the aorticopulmonary window. A 61-year-old woman with primary hyperparathyroidism had a preoperative thallium-technetium subtraction scan that showed thallium uptake at the base of the heart without any uptake in the neck. After further workup and without prior neck exploration, a parathyroid adenoma was found in the aorticopulmonary window through a median sternotomy. Six months later, serum calcium, phosphorus, and parathyroid hormone values remain normal. Two other cases of parathyroid adenoma in the aorticopulmonary window are presented. Of these two patients, the thallium scan was a key element in the immediate mediastinal exploration of one, who was transferred from another hospital comatose and intubated, in acute hypercalcemic crisis. Since mediastinal parathyroid tumors that necessitate median sternotomy occur in less than 2% of patients with primary hyperparathyroidism, we do not advocate routine preoperative localization studies before an initial cervical operation; localization, however, may be justified in selected cases, such as in critically ill patients or in instances of acute hyperparathyroidism, when the first operation needs to be curative.

• Research Organization: Loyola Univ. Medical Center, Maywood, IL (USA)
• OSTI ID: 6516775
• Journal Information: Surgery; (United States), Journal Name: Surgery; (United States) Vol. 104:6; ISSN SURGA
• Country of Publication: United States
• Language: English

Related Subjects

550600 -- Medicine
550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
ADENOMAS
BODY
BODY AREAS
COUNTING TECHNIQUES
DIAGNOSIS
DISEASES
ENDOCRINE DISEASES
ENDOCRINE GLANDS
GLANDS
HYPERPARATHYROIDISM
ISOTOPES
MEDICINE
NECK
NEOPLASMS
ORGANS
PARATHYROID GLANDS
PATIENTS
RADIOISOTOPE SCANNING
SURGERY
TECHNETIUM ISOTOPES
THALLIUM ISOTOPES