Spontaneous neck hematoma due to rupture of parathyroid adenoma: report of 3 cases and literature review.

Spontaneous hemorrhage from a parathyroid adenoma is an extremely rare but potentially serious complication. Clinical signs and symptoms depend on the volume and location of the hematoma and include a mass in the neck, ecchymosis, pain, and symptoms from the compression of adjacent structures. In extreme cases, the hemorrhage may extend to the mediastinum and the pleural cavity, causing chest pain, cough, and respiratory failure. Imaging tests are helpful to guide diagnosis. Both computed tomography (CT) and magnetic resonance imaging (MRI) allow for identifying the anatomical structures and the extent of the bleeding. Differential diagnosis should be made with thyroid gland lesions, superior vena cava syndrome, aortic dissection, or complication of a mediastinal lesion. Urgent treatment with evacuation of cervical hematoma may be required when airway involvement, hypercalcemic crisis, or active bleeding exist. The aim of this study was to review our cases to clarify the prevalence and treatment of this complication. Three cases of primary hyperparathyroidism which appeared as spontaneous neck hematoma recorded in the prospective database of 560 parathyroidectomies from the endocrine surgery unit of our institution were collected. The first case was a 56-year-old woman with a history of high blood pressure and cholecystectomy. She attended the emergency room for sudden pain in the anterior neck region, and reported no prior trauma or anticoagulant or anti-inflammatory treatment. Physical examination revealed blood pressure levels of 190/120 mmHg and ecchymosis in the anterior neck area. Supplemental tests showed hypercalcemia (calcium level, 10.9 mg/dL) and a parathormone (PTH) level of 145 pg/mL. A CT scan of the neck and chest showed diffuse occupation of the left anterior and posterior neck by a hematoma. A tubular lesion