Kamli Rani, 75 year 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 Ca+2 13.0 mg/L and urinary Ca+2 is 300 mg/24 h. On examination there is small mass in the paratracheal 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 sitting 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, Ref: Harrison 19th edition Pgno: 2470
Repeat neck surgery
Treatment with Technitium-99
Observation and repeat serum Ca+2 in two months
Ultrasound-guided alcohol injection of mass
Endocrinology and breast