Clinical and Experimental Otorhinolaryngology Vol. 1, No. 1: 46-48, March 2008 DOI 10.3342/ceo.2008.1.1.46 Case Report Non-Functional Parathyroid Adenoma Presenting as a Massive Cervical Hematoma: A Case Report Woo Sub Shim, MD In Kyeong Kim, MD Seung Du Yoo, MD Dong Hwal Kim, MD Department of otorhinolaryngology, College of Medicine, Chungbuk National University, Cheongju, Korea Parathyroid adenoma usually manifests with symptoms related to hypercalcemia, such as urinary stone and bone fracture. It may also present with asymptomatic hypercalcemia. However, spontaneous cervical hematoma may occur very rarely as a result of extracapsular hemorrhage of a cervical parathyroid adenoma causing acute painful cervical swelling, bruising, dyspnea, hoarseness and dysphagia. We report a 44-year-old woman who manifested as a spontaneous cervi- cal hematoma without any clinical evidence of hyperparathyroidism. Key Words. Neck, Hematoma, Parathyroid neoplasm INTRODUCTION Spontaneous cervical hemorrhage may occur after trauma to the cervical vertebrae, infection, injury of the great vessels, violent head movement, cardiac catheterization or catheterization for intracranial angiography, foreign body ingestion, a parathyroid adenoma and etc. It may be caused by anticoagulation therapy or coagulopathy (1-3). Cervical hematoma presents as acute painful swelling and bruising of neck, and this is associated with dyspnea, hoarseness and dysphagia caused by compression on the surrounding organs such as the trachea, esophagus and recurrent laryngeal nerve (2, 4, 5). Parathyroid adenomas usually manifest symptoms related to hypercalcemia such as urinary stone, bone fracture, dehydration and so on (1, 2, 6). It may be encountered as asymptomatic hypercalcemia, but as a very rare situation, it may present as a massive cervical hematoma. We report an unusual case of spontaneous cervical hematoma arising from the parathyroid adenoma with normal parathyroid hormone (PTH) level. Received January 1, 2008. Accepted after revision March 15, 2008. Corresponding author : Woo Sub Shim, MD Department of Otorhinolaryngology, College of Medicine, Chungbuk National University, San 62 Gaesin-dong, Heungdeok-gu, Cheongju, Korea Tel : +82-43-269-6157, Fax : +82-43-265-6157, E-mail : hwatas@dreamwiz.com 46 CASE REPORT A 44-year-old woman developed painful swelling of the anteri- or neck. She also suffered from hoarseness, headache on the right occipital area and pain radiating to her right shoulder and forearm. The patient denied any symptoms of upper respiratory infection or pharyngitis, and she had no previous history of drug use, medical procedure, trauma or foreign body ingestion. On physical examination, vital signs were stable and there was diffuse, ecchymotic swelling and tenderness, but no sensation of heat or erythema in the neck. Laryngeal examination revealed right vocal cord paresis. On the routine blood laboratory findings, there was no evidence of acute infection (white blood cells: 7,230/ L, C-reactive protein: 0.23 mg/dL) and coagulopathy (pro- thrombin time: 10.5 sec, active partial thromboplastin time: 25.8 sec, bleeding time: 3 min). CT scanning of the neck showed an ill defined nonenhancing soft tissue density between the right carotid space and thyroid gland (Fig. 1A). Under the impression of hematoma, sonogra- phy-guided aspiration was performed and 10 cc of old blood was aspirated. After that, a 2 cm sized heterogenous, echogenic mass was revealed in the right infrathyroid region (Fig. 1B). To rule out parathyroid abnormality, we performed further blood chemical assessment of the parathyroid function, but it proved to be within the normal limits (calcium: 8.2 mg/dL, phosphate: 2.8 mg/dL, PTH: 41.4 pg/mL). Sestamibi scintigra- phy revealed no specific findings. The patient persisted vocal cord paresis despite improvement of pain after aspiration.