Kamli Rani, 75-years -old woman present with post myocardial infarction after 6 weeks mild CHF. There was past H/O neck surgery for parathyroid adenoma 5 years ago, ECG shows slow atrial fibrillation. Serum Ca2+ 13.0 mg/L and urinary Ca2+ is 300 mg/24 hr. On examination there is small mass in the Para tracheal position behind the right clavicle. Appropriate management at this time is:
Patient is a case of recurrent hyperparathyroidism, as she was operated previously for parathyroid adenoma. In the setting of recent myocardial infarction, CHF and atrial fibrillation, any operation carries a high risk. Ultrasound-guided alcohol injection in the mass is preferred in this setting.
Repeat neck surgery
Treatment with technetium-99
Observation and repeat serum Ca2+ in two months
Ultrasound-guided alcohol injection of the mass
Parathyroid and adrenal glands