DefinePK

Research Objective

To present a case of ectopic parathyroid adenoma located in the mediastinum and its surgical excision via a video-assisted thoracoscopic approach.

Methodology

Case report detailing the diagnostic workup and surgical management of a patient with an ectopic mediastinal parathyroid adenoma. Diagnostic tools included ultrasound, CECT neck and chest, and sesta-MIBI scan. Surgical intervention was performed using video-assisted thoracoscopic surgery (VATS). Intraoperative intact PTH measurement was used to confirm adenoma removal.

Methodology Flowchart

                        graph TD;
    A["Patient Presentation with Symptoms"] --> B["Investigations: Ultrasound, CECT, Sesta-MIBI"];
    B --> C["Diagnosis: Ectopic Mediastinal Parathyroid Adenoma"];
    C --> D["Surgical Planning: VATS"];
    D --> E["VATS Procedure: Adenoma Excision"];
    E --> F["Intraoperative PTH Monitoring"];
    F --> G["Post-operative Assessment"];
    G --> H["Histopathology Confirmation"];
    H --> I["Patient Discharge"];                    

Discussion

Ectopic parathyroid adenomas can cause refractory hyperparathyroidism and pose diagnostic and surgical challenges. While most parathyroid adenomas are in the neck, a small percentage are mediastinal. VATS is a preferred minimally invasive approach for excising mediastinal adenomas when a cervical approach is not feasible. Intraoperative PTH monitoring is crucial for confirming successful resection.

Key Findings

A 45-year-old female with symptoms of bone pain and elevated serum calcium and PTH levels was diagnosed with an ectopic mediastinal parathyroid adenoma. The adenoma was successfully excised using VATS. Post-operative PTH levels dropped significantly, confirming successful removal. Histopathology confirmed the presence of an ectopic parathyroid gland embedded within the thymus gland.

Conclusion

Video-assisted thoracoscopic surgery is an effective and minimally invasive approach for the excision of ectopic mediastinal parathyroid adenomas, offering good visualization and patient recovery.

Fact Check

1. Incidence of ectopic mediastinal parathyroid adenoma: The text states that 1-2% of parathyroid adenomas are located in the mediastinum.
2. Patient's age: The patient presented at 45 years old.
3. Post-operative PTH levels: Pre-operative PTH levels dropped from 16.5 mmol/l to 1.62 mmol/l post-operatively.

Mind Map