Transcervical resection of an ectopic mediastinal parathyroid adenoma.

An 81-year-old man was incidentally found to have a posterior mediastinal lesion measuring 25 x 19 mm behind the trachea and lateral to the esophagus on com- puted tomography of the chest. Parathyroid scintigraphy with 99mTc-MIBI (technetium with the ligand methoxyisobutylisonitrile) showed persistent focal activity in the posterior mediastinum along the left lateral aspect of the esophagus. Bronchoscopic examination showed a protrusive mass beneath the membranous part of the trachea, which was remarkably elevated in the expira- tory phase. The endobronchial ultrasound convex probe showed a multicystic posterior mediastinal mass with min- imal vascularization by the Doppler mode imaging. The result of following endobronchial ultrasound– guided trans- bronchial needle aspiration of the lesion, was consistent with a parathyroid tumor. Endocrinologic studies revealed a primary hyperparathyroidism with an intact parathyroid hormone level of 66.1 pmol/L (normal range, 1.3–7.6 pmol/L).