Video-assisted thoracoscopic surgery as a first-line treatment for mediastinal parathyroid adenomas: strategic value of imaging

L Amar, L Guignat, F Tissier, B Richard, O Vignaux, Y Fulla, P Legmann, X Bertagna, P Bonnichon
2004 European Journal of Endocrinology  
Objective: To present first-line thoracic surgery made possible by localization studies in three patients with ectopic parathyroid adenomas. Design and methods: Three patients with ectopic parathyroid tissue in the mediastinum were examined by ultrasound, technetium-99m sestamibi scintigraphy, computed tomography (CT), and venous catheterization with measurement of parathyroid hormone. Without previous cervical exploration, video-assisted thoracic surgery (VATS) was used in all cases to avoid
more » ... ll cases to avoid the need for thoracic open surgical procedures. Results and conclusions: The mediastinal parathyroid glands were all detected at scintigraphy, and CT and venous catheterization were helpful in anatomic and functioning characterization. All pathologic glands were successfully resected, with only one minor complication. VATS can safely remove a deep mediastinal parathyroid adenoma and avoid more aggressive open approaches. In an experienced referral center, systematic and sophisticated imaging studies may accurately identify and localize rare ectopic parathyroid adenomas, and avoid cervical surgery. European Journal of Endocrinology 150 141-147 Methods Preoperative cervical ultrasound and Tc99m-sestamibi scintigraphy for primary hyperparathyroidism have been performed in all patients in our Department since 1993, always by the same operator (B R). After placing the patient in the supine position with the neck slightly extended, a complete sonographic survey
doi:10.1530/eje.0.1500141 pmid:14763911 fatcat:3yiwymlb4nhzbnqlzvvhqybmju