Abstract
In most cases of persistent or recurrent hyperparathyroidism (HPT), the pathological parathyroid (PT) will be in the neck or accessible through the cervical approach, and in only a small percentage will median sternotomy be required. We present 3 cases of persistent HPT where the PT tissue was in the middle mediastinum. We acknowledge that this is a rare occurrence and that it cannot be explained adequately by standard embryological teaching. In cases requiring formal mediastinal exploration, the mediastinal exploration is not complete unless the middle mediastinum is carefully explored to exclude ectopic PT tissue.
Résumé
Dans la plupart des cas d'hyperparathyroïdie (HPT) persistante ou récidivante, la glande parathyroïdienne (PT) pathologique responsable se trouve souvent dans le cou ou est au moins accessible par une incision cervicale. Il est rare qu'une sternotomie médiane soit nécessaire. Nous présentons 3 cas d'HPT persistante dans lesquels la glande PT restante se trouvait dans le médiastin moyen. Nous reconnaissons qu'il s'agit d'une éventualité rare qui ne peut être expliquée par l'embryologie classique. Dans les cas où une exploration médiastinale réglée est nécessaire, il faut, pour être complet, ne pas oublier d'explorer le médiastin moyen pour exclure toute possibilité d'existence de tissu PT ectopique.
Resumen
En la mayoría de los casos de hiperparatiroidismo persistente o recurrente la glándula patológica se encuentra en el cuello o es accessible por un abordaje cervical, y sólo en un mínimo porcentaje se hace necesario realizar esternotomía. Presentamos 3 casos de hiperpartiroidismo persistente en los cuales el tejido paratiroideo anormal fue hallado en el mediastino medio, posterior al arco aórtico pero anterior a la carina y a los bronquios principales. Reconocemos que este es un hallazgo raro y que no puede ser adecuadamente explicado a la luz de los conocimientos embriológicos ordinarios. En casos que requieran exploracíon mediastinal formal, la exploración no puede ser considerada como completa a menos que el mediastino medio sea cuidadosamente inspeccionado a fín de excluir la presencia de tejido paratiroideo ectópico.
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Curley, I.R., Wheeler, M.H., Thompson, N.W. et al. The challenge of the middle mediastinal parathyroid. World J. Surg. 12, 818–822 (1988). https://doi.org/10.1007/BF01655485
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DOI: https://doi.org/10.1007/BF01655485