Spontaneous mediastinal hematoma as initial presentation of cystic adenoma of ectopic parathyroid

Abstract

Atraumatic spontaneous mediastinal hematomas are uncommon. They are secondary to trauma, rupture of great vessels or heart and associated to iatrogenic events. We report a case of a 61 year-old woman who consults for mediastinal hematoma without previous trauma. Imaging studies ruled out cardiac or vascular lesions. At exploratory thoracotomy, a large mediastinal hematoma was evidenced without obvious mass or bleeding vessel. The material sent to the Pathology service was diagnosed as cystic adenoma of ectopic parathyroid gland. Mediastinal hematomas are related to traumatic causes, cardiac or great vessels rupture or iatrogenic proceedings. Once these causes are ruled out, an injury of ectopic parathyroid tissue must be considered in the differential diagnosis because mediastinum is the most frequent ectopic location. Histopathological and immunohistochemical studies are useful in determining the cause-related hematoma, as in this case determined the parathyroid origin of the lesion, and to rule out involvement by other tumors.