Acute extracapsular parathyroid hemorrhage: case report and review of the literature

To describe a patient with extracapsular parathyroid hemorrhage and review the signs and symptoms of this condition. We report a case of extracapsular parathyroid hemorrhage in a patient with primary hyperparathyroidism and present an overview of previously reported cases. A 48-year-old woman with documented primary hyperparathyroidism, who was awaiting surgical intervention, had acute onset of a neck mass, neck pain, and dysphagia. She was found to have sustained a spontaneous extracapsular hemorrhage of a parathyroid adenoma. Hypercalcemia persisted, and she subsequently underwent curative parathyroidectomy for the primary hyperparathyroidism. We also identified 15 previously reported cases of extracapsular parathyroid hemorrhage and summarized the most common manifestations-most notably, a neck mass or swelling, ecchymoses of the neck and chest, dysphagia, neck pain, hoarseness, and dyspnea. Clinicians should be aware of the potential for occurrence of extracapsular parathyroid hemorrhage in patients with primary hyperparathyroidism. When this condition occurs, severe hypercalcemia or acute hypocalcemia may be present. Hypercalcemia is often persistent; however, autoinfarction of the parathyroid adenoma is possible.