James K. Fortson

Parathyroid cysts : A case report and review of the literature

Objectives/Hypothesis Parathyroid cysts are rare clinical entities. They frequently present as a clinical diagnostic problem. They may mimic solitary thyroid nodules. The purpose of the study was to review the literature and present a case of a 22‐year‐old euthyroid woman presenting with recurrent swelling in the neck. Her complaints included choking and dysphagia. Fine‐needle aspiration of the mass revealed clear, watery fluid with an extremely high level of calcium and c‐terminal midmolecule parathyroid hormone assay in excess of 8000 pg/mL. Treatment consisted of neck exploration and removal of a 6 × 5‐cm cystic encapsulated mass. Pathological diagnosis revealed a benign parathyroid cyst. The role of needle aspiration in diagnosing thyroid masses and the importance of parathyroid hormone assay in diagnosing parathyroid cyst are emphasized.

Otolaryngologic manifestations of orbital pseudotumors.

Orbital pseudotumor is believed to be a nonspecific, acute or chronic inflammatory process involving the intraorbital soft tissue. Orbital pseudotumor may masquerade as sinusitis with orbital complications or as a severe upper respiratory tract infection. Five cases are presented to illustrate the difficulties in diagnosis when initial symptoms relate to the upper respiratory system rather than to an isolated orbital mass. In these cases, orbital ultrasound and computed tomograms were helpful in making the diagnosis. Treatment consisted of systemic corticosteroids in four of the five patients. Recognition of early symptoms and findings, along with earlier involvement with the ophthalmologist, will make a more effective treatment regimen possible.

Sigmoid sinus thrombosis associated with a parapharyngeal deep lobe parotid gland tumor causing seizure

Deep lobe tumors of the parotid gland comprise less than 10 percent of all parotid gland tumors, and less than one percent of parotid gland tumors fill the parapharyngeal space. We present an unusual case of a deep lobed parotid gland tumor that occupied the parapharyngeal and pterygomaxillary space with extension to the skull base, causing occlusion of the jugular vein with subsequent thrombosis of the sigmoid and transverse sinuses. The resultant intracranial venous hypertension caused symptoms of tonic-clonic seizures that, to the best of our knowledge, have not been previously reported.

Detection and treatment of mediastinal parathyroid adenomas

Detection and Treatment of Mediastinal Parathyroid Adenomas JAMES K FORTSON MD MBA; LANERDO THOMPSON MD; Atlanta GA; San Francisco CA Objectives: To evaluate the accuracy of serum calcium levels in detecting, localizing, and treating mediastinal parathyroid adenomas after cervical exploration. Methods: A retrospective cohort study of 83 patients with primary hyperparathyroidism during a 13-year period was reviewed; 86% of these patients had cervical adenomas, and 14% had naediastinal adenomas. Neck exploration was performed for all cervical adenomas, and mediary sternotomy was performed in patients with mediastural adenomas. Results: Serum calcium levels dropped in patients with cervical adenomas if an adenoma remained in the neck. No decline in calcium levels was noted in patients with mediastinal adenomas. CT scans were of little value in localizing parathyroid adenomas. Accurate localization and detection of parathyroid adenomas was most successful when selective venous evaluation of PTH levels in the great veins was performed. Conclusion: Mediastinal parathyroid adenomas should be suspected if serum calcium levels do not fall after cervical exploration.