Ectopic intra-vagal parathyroid adenoma.

Abstract

Intraneural parathyroid adenomas are rare, with only nine cases of intravagal adenomas reported. All but one of the reported cases were found following multiple neck explorations. We report the first case of non-supernumerary ectopic intravagal parathyroid identified at primary exploration.A 17 year old girl with primary hyperparathyroidism and nephrolithiasis was referred with a sestamibi scan reporting a left lower parathyroid adenoma. No eutopic parathyroid tissue was identified during full exploration of the left neck. Exploration of the carotid sheath revealed a fusiform swelling of the vagus nerve at the carotid bifurcation. Longitudinal incision of the vagal perineurium revealed a 7mm parathyroid adenoma, which was enucleated. The patient recovered uneventfully, with normalization of serum calcium and parathyroid hormone (PTH), and normal vocal cord function.This is the first reported case of non-supernumerary intravagal parathyroid adenoma resected at initial exploration. The vagus nerve is a rare location for a parathyroid adenoma, but one that should be considered, even during primary exploration. This article is protected by copyright. All rights reserved.