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Orlo H. Clark, MD

Arch Surg. 1988;123(9):1096-1100.

Abstract
• Mediastinal parathyroid tumors are a frequent cause of failed parathyroid operations. I therefore reviewed my experience with 285 consecutive patients treated surgically for hyperparathyroidism from January 1981 to Dec 31, 1986. Two hundred eighty-eight operations were performed on these patients (246 primary, 38 secondary, one error in diagnosis, and 53 reoperations). Mediastinal parathyroid tumors were present in 64 (22%) of the entire group of 285 patients with hyperparathyroidism, and 20 (38%) of 53 patients requiring reoperation for persistent or recurrent hyperparathyroidism. Fifty-two parathyroid tumors were situated in the anterior mediastinum and 12 were found in the posterior mediastinum; 56 of the mediastinal tumors were removed via a cervical approach. In four patients the mediastinal tumor was a fifth histologically documented parathyroid gland. Mediastinal tumors were identified by preoperative localization studies (ultrasonography, three [16%]; thallium-technetium, five of 17 [29%]; computed tomography, eight of 14 [57%]; magnetic resonance imaging, three of seven [43%]; and selective venous catheterization for parathyroid hormone, ten of 11 [91%]). Awareness of the relatively high occurrence of mediastinal tumors (52 anterior, 12 posterior) should decrease the risk of failed parathyroid operations.

(Arch Surg 1988;123:1096-1100)

Author Affiliations
From the Surgical Service, Veterans Administration Medical Center, San Francisco, and the Department of Surgery, University of California, San Francisco.

Footnotes
Accepted for publication May 18, 1988.

Presented in part at the British Association of Endocrine Surgeons, Edinburgh, May 22, 1987; and read before the 59th Annual Meeting of the Pacific Coast Surgical Association, San Francisco, Feb 22, 1988.

Reprints not available.

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