THORACOSCOPIC EXCISION OF ENLARGED MEDIASTINAL PARATHYROID-GLANDS

Background. Most abnormal parathyroid glands can be removed through th e neck, but those deep in the chest have required sternotomy or thorac otomy. To avoid the morbidity of these open procedures, ectopic parath yroid glands deep in the chest were removed with video-assisted thorac ascopy. Methods. Two patients with persistent primary and two with per sistent secondary hyperparathyroidism had technetium-thallium scintigr aphy and computed tomography of the chest to localize their ectopic gl ands. Video-assisted thoracoscopy was used for operative removal of th ese glands in each patient. Results. Parathyroid scans identified a me diastinal gland that was confirmed and localized precisely by the comp uted tomography scan. An enlarged ectopic gland weighing 1 to 2 gm was removed from each patient with normalization of serum calcium level. Glands were found by the main pulmonary artery, aortopulmonary window, ascending aorta, and aortic arch. One patient had recurrent disease 9 months later. Conclusions. Removal of parathyroid glands deep in the chest with video-assisted thoracoscopy is a safe and successful altern ative to median sternotomy.