75 yrs old woman present with post-myocardial infarction after 6 weeks with mild CHF. There was past H/O neck surgery for parathyroid adenoma 5 years ago, EKG shows slow atrial fibrillation. Serum Ca+2 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 -
This patient operated previously for parathyroid adenoma, is having recurrent hyperparathyroidism. In the setting of recent myocardial infarction, CHF and atrial fibrillation, any operation carries a high risk. Fuhermore, an operation on a previously operated neck is quite difficult. Alcohol ablation of the mass with ultrasound guidance or angiographic embolization is preferred in this setting.
Repeat neck surgery
Treatment with technetium-99
Observation and repeat serum ca in 2 months
Ultrasound guided alcohol injection of the mass
Endocrinology and breast