PMC4334879_01
PMC4334879_02
Transcutaneous echography. Sagittal section. (a) A nonhomogenous structure in cervical-mediastenal area, to the right of the thyroid gland. (b) An isoechoic nonhomogenous structure sized up to 3 cm is adjacent to the posterior surface of thyroid gland, with an apparent capsule (1) (parathyroid gland adenoma with hemorrhage). A hypoechoic to echonegative area spreads from the structure into mediastenal septum and into the anterior neck surface (2) (a cervical-mediastenal hematoma).
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A nonhomogenous structure with contained liquid and abnormally high blood circulation, which was spreading over the posterior surface of the thyroid gland into mediastinal septum was determined one day later, during echography of the thyroid gland (Fig. 1).
PMC4334879_03
Multi-slice CT scan with angiography: (a) 3D reconstruction. Deformation of the anterior neck surface with shift of thyroid gland by a non-vascular lesion (hematoma) and (c) axial scan. A mass lesion compressing the tracheal lumen is located to the right of the thyroid gland. Extravasation of contrast media into hematoma volume is observed in the bifurcation zone of inferior thyroid artery. (b) Multi-slice CT scan: Frontal scan. A mass lesion is located to the right of the thyroid gland, propagating into mediastenal septum and compressing the tracheal lumen.
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A tense hematoma (Fig. 2) and hemorrhage into the hematoma cavity from the branch of inferior thyroid artery were visualized on a multi-slice CT scan with angiography.
PMC4334879_04
Microphotography of operative material. Tinted with hematoxylin and eosine. Magnification x400. (a) Hematoma wall is composed of fibrous connective tissue, sediment of hemosiderin, fragment of fat tissue, lymphoplasmocitary infiltration. (b) Hematoma wall is composed of fibrous connective tissue, vessels, small fragments of parathyroid gland tissue in fibrous tissue. (c) Tissue of parathyroidgland adenoma with focal hemorrhage.
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Histological examination discovered the fragments of parathyroid adenoma in the hematoma wall (Fig. 3).