Kamli Rani 75 yrs old woman present with post myocardial infarction after 6 weeks with mild CHF. There was past WO neck surgery for parathyroid adenoma 5 years ago, EKG shows slow atrial fibrillation. Serum Ca+213.0 mg/L and urinary Ca2+ is 300 mg/ 24 hr. On examination their is small mass in the Para tracheal position behind the right clavicle. Appropriate management at this time is -
Ans. is 'd' i.e., Ultrasounded guided alcohol injection of mass 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+2 in two months
Ultrasound-guided alcohol injection of the mass