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Spontaneous neck hematoma secondary to parathyroid adenoma: a case series

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A Correction to this article was published on 29 April 2020

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Abstract

Purpose

Spontaneous neck hematoma is a rare yet potentially fatal complication of primary hyperparathyroidism (PHPT). Here we aim to describe novel presentations of neck hematomas secondary to PHPT, discussing tools and signs that facilitate diagnosis.

Methods

Case series data were extracted by retrospective chart reviews of our institution's electronic medical records, including all neck hematoma cases from parathyroid origin between 2005 and 2020. Cases from PubMed and EMBASE between 1999 and 2020 were analyzed in a systematic literature review.

Results

Four patients were identified with five acute bleeding events, including a novel report of recurrent neck hemorrhage due to parathyroid adenoma. There was postmenopausal female predominance (75%), consistent with previous reports (72.7%). Common presentations included neck pain, dysphagia and hoarseness. All bleedings spread into the retropharyngeal space. Vocal cord paralysis was found in a single case and in 8.6% of the benign lesions in the reviewed cases. A single case presented with normal calcium levels (20% of bleeding episodes), in line with the reviewed cases (17.4%). A subtle CT sign of an enhancing area within the parathyroid gland, which led to the diagnosis, was identified in a single case. Conservative treatments were employed in 80% of our cases and in 51.5% of the reviewed cases, all being successful. Neck explorations performed after a 3-month waiting period from the acute event demonstrated better results compared to immediate surgery.

Conclusion

A high suspicion index is needed, particularly in post-menopausal women, to reach a diagnosis and allow optimal management. Normal laboratory values do not exclude parathyroid etiology, yet assessment should include calcium and PTH levels along with targeted imaging. Since bleeding may recur, we suggest that PHPT complicated with neck hematoma should be an independent indication for definitive parathyroidectomy surgery.

Level of evidence

3b

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Change history

  • 29 April 2020

    In the original publication of the article, one of the author name was published incorrectly.

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Funding

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Author information

Author notes

  1. Idit Tessler and Meital Adi contributed equally to the article.

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel

    Idit Tessler, Yonatan Lahav, Doron Halperin & Oded Cohen

  2. Department of Radiology, Kaplan Medical Center, Rehovot, Israel

    Meital Adi

  3. Department of Pathology, Kaplan Medical Center, Rehovot, Israel

    Judith Diment

  4. Hebrew University and Hadassah Medical School, Jerusalem, Israel

    Idit Tessler, Meital Adi, Judith Diment, Yonatan Lahav, Doron Halperin & Oded Cohen

Authors
  1. Idit Tessler
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  2. Meital Adi
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  3. Judith Diment
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  4. Yonatan Lahav
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  5. Doron Halperin
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  6. Oded Cohen
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Correspondence to Oded Cohen.

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The authors declare that they have no competing interest.

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The study was approved by Kaplan Medical Center's review board.

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The original version of this article was revised due to one of the co-author name was published incorrectly published as "Judith Diamant" and corrected in this version.

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Tessler, I., Adi, M., Diment, J. et al. Spontaneous neck hematoma secondary to parathyroid adenoma: a case series. Eur Arch Otorhinolaryngol 277, 2551–2558 (2020). https://doi.org/10.1007/s00405-020-05959-z

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