Endocrine Abstracts

Background: Spontaneous haemorrhage of a parathyroid adenoma or hyperplastic gland can cause retropharyngeal haematoma. This rare but potentially life-threatening condition may present with acute neck pain, dysphonia, dysphagia, and in severe cases, airway obstruction. Fewer than 50 cases have been reported, with only a minority progressing to airway compromise -8.8% required emergency intubation and 4.4% required a tracheotomy.

Case Presentation: We report a case of a 65-year-old female patient with end-stage renal disease and tertiary hyperparathyroidism. She presented with acute neck pain, hoarse voice, and dysphagia. Contrast-enhanced Computed Tomography (CT) demonstrated an ill-defined retropharyngeal hyperdensity with significant narrowing of the pharyngeal airway. Differential diagnoses included malignancy and atypical infection. She underwent pre-emptive intubation to secure the airway and proceeded to a surgical tracheostomy. Initial fine needle aspiration was non-diagnostic; open exploration with repeat biopsy identified an infarcted left retropharyngeal parathyroid gland. Histology confirmed a parathyroid adenoma with hyperplasia and organising haematoma, consistent with recent acute haemorrhage.

Discussion: Retropharyngeal haemorrhage from parathyroid adenoma or hyperplasia is rare but potentially life-threatening. This case highlights the need to consider acute haemorrhage as a differential for equivocal imaging in acute presentations. This is particularly relevant in patients with hyperparathyroidism, alongside commoner causes such as malignancy and infection. In suspected upper airway compromise of unknown cause, early ENT and anaesthetic input with airway assessment, plus prompt CT imaging help guide management and confirm diagnosis.

Conclusion: We describe a rare case of parathyroid adenoma and hyperplasia complicated by acute haemorrhage, presenting as a retropharyngeal mass with airway compromise. Recognition of this entity is critical for timely diagnosis and intervention.