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Ann Thorac Surg 2005;79:1097
© 2005 The Society of Thoracic Surgeons

Correspondence

Mediastinal Parathyroid Adenoma

Thomas J. Birdas, MD, Robert J. Keenan, MD

Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, 15212

(E-mail: tbirdas1{at}aol.com).

To the Editor:

We read the article by Shende and colleagues [1] with great interest. We recently treated a 16-year-old male patient with primary hyperparathyroidism and an ectopic mediastinal adenoma. He had markedly elevated calcium (total calcium 15.6 mg/dL; normal 8.5 to 10.5 mg/dL) and intact parathyroid hormone levels (iPTH 3,690 pg/mL; normal 11 to 68 pg/mL). A technetium-99m sestamibi scan showed increased activity in the right superior mediastinum (Fig 1). A right thoracoscopic exploration was performed; the ectopic adenoma was identified anterior to the junction of the right atrium and superior vena cava (Fig 2) and removed. Intraoperative PTH assay showed a marked decrease after the resection (911 to 318 pg/mL). Postoperatively, the calcium and PTH levels returned to normal. A single chest tube was removed on the first postoperative day. Pathology examination confirmed the diagnosis of a parathyroid adenoma.



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  		Fig 1. Technetium-99m sestamibi scan showing enhanced activity in the superior mediastinum.

 


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  		Fig 2. Intraoperative view during right thoracoscopy. The adenoma is denoted by the asterisk. (CW = chest wall; RA = right atrium; SVC = superior vena cava).

 
We believe, as has previously been documented [2, 3], that median sternotomy for intrathoracic parathyroid adenomas can be avoided, as these tumors are easily accessible through a thoracoscopic approach.


   References
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 References
 

  1. Shende MR, Pusca SV, Quinlan Jr DP, et al. Intrathoracic parathyroid adenoma Ann Thorac Surg 2004;77:724.[Free Full Text]
  2. Onoda N, Ishikawa T, Yamada N, et al. Radioisotope-navigated video-assisted thoracoscopic operation for ectopic mediastinal parathyroid Surgery 2002;132:17-19.[Medline]
  3. Smythe WR, Bavaria JE, Hall RA, et al. Thoracoscopic removal of mediastinal parathyroid adenoma Ann Thorac Surg 1995;59:236-238.[Abstract/Free Full Text]




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