Thoracoscopic Resection of Giant Mediastinal Parathyroid Tumor

Shalini Reddy, MD, Steven D Schwaitzberg, MD. Cambridge Health Alliance, Harvard Medical School

 

Giant mediastinal parathyroid lesions (< 4cm) though rare, have been reported in the literature. The approach to these large lesions has primarily been via a throracotomy. This video demonstrates the thoracoscopic resection of one of the largest parathyroid lesions reported in the literature measuring 8cm ( nl = 4-6mm) and weighing 32gram (nl = 25-35 mg). This profoundly lethargic 78 year old man presented to the emergency department in acute renal failure with a serum calcium of 18mg/dl ( nl < 10.4) and a parathyroid hormone (PTH) of 1447 pg/mL. ( nl < 88). A Technitium 99 sestamibi scan demonstrated an ill defined mass in the mediastinum. MRI showed an 8 cm lesion just to the right of the trachea and esophagus in the posterior mediastinum that was hyperintense on T2 weighted signals . The lesion was resected using a right (side up) lateral thoracoscopic approach with ports placed in the 2nd, 4th and 6th interspaces.
Histologic examination revealed a benign parathyroid adenoma. Serum calcium and creatinine have returned to normal and the patient has made a complete recovery. Thoracoscopic resection of mediastinal parathyroid tumors can be applied to even very large lesions with precision and minimal blood loss.
 


Session Number: SS21 – Videos: Solid Organ & Foregut
Program Number: V049

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