Spontaneous cervical hematoma due to rupture of a parathyroid adenoma

53-year-old male arrives with a week old spontaneous neck swelling with ecchymosis and showing no further complaints, associated pain, or respiratory distress. There is not any allergic or personal history of interest, known co-morbid illnesses, or family history of cancer. The possible causes for neck volume increase include thyroid injuries, mediastinal injuries, or vascular injuries such as aortic dissection or superior vena cava syndrome. We chose to perform a neck ultrasound and found a hypoechogenic, extrathyroidal nodule with well-defined borders and peripheral vascularization behind the right thyroid lobe with an underlying hypoechoic collection measuring 15 mm in the widest axis attached. It is interpreted as a small hemorrhage caused by a parathyroid adenoma, later confirmed by a biochemistry blood test with the finding of hypercalcemia

Spontaneous cervical hematoma caused by the rupture of a parathyroid adenoma is an infrequent pathology.The clinical expression is cervical mass, ecchymosis, pain, and symptoms of compression in the neighboring structures. Occasionally the bleeding may spread up to the mediastinum and the pleural cavity causing chest pain, cough, and respiratory insufficiency. The causes for the rupture of the parathyroid adenoma are not known with certainty, it could be due to imbalance in the growth of the gland and in the blood supply, generating a gland infarction with hemorrhage that can be spread extracapsularly. (1) The diagnosis is established when the following criteria are met: neck acute swelling, hypercalcemia, and cervical and / or thoracic ecchymosis. (2) The initial exploration is done by ultrasound examination, but if there are signs of respiratory or vascular compromise, CT with contrast is preferred. Parathyroids adenomas are seen on ultrasound as solid oval-shapednodules, which are well-defined, homogenous, and hypoechogenic. Hematomas are seen on ultrasound as a collection with diffuse or inhomogeneous echogenicity. (3)

Spontaneous cervical hematoma caused by the rupture of a parathyroid adenoma should be considered in the differential diagnosis of acute neck swelling pathology. Ultrasound can guide the diagnosis in mild cases of spontaneous cervical hematoma. However, CT scan of the neck with contrast will be the initial test if there is respiratory or vascular compromise.

- Osorio Silla, I., Lorente, L., Sancho, J. and Sitges-Serra, A. Hematoma cervical espontáneo por rotura de un adenoma de paratiroides: 3 casos y revisión de la literatura. Endocrinología y Nutrición (2014), 61(1), pp.e5-e6. -