Endocrine Abstracts

Parathyroid cysts are rare, usually asymptomatic and typically present as a neck lump. They are most commonly detected in middle-aged women and can occasionally present with compressive symptoms. True parathyroid cysts are non-functional and benign in nature, allowing a more conservative approach to their management in many patients. We present the case of an 82-year-old lady with a past medical history of a presumed parathyroid cyst which was drained by the ENT surgeons. Three years later, she presented to hospital with sudden onset shortness of breath, throat pain and three months of increasing dysphagia. Examination and initial investigations were consistent with upper airway obstruction and a chest radiograph showed a large retrosternal mass. Computed tomography revealed a large 8×5 cm cyst causing tracheal compression and deviation. The patient underwent drainage of the cyst via ultrasound and fluoroscopic guidance with full resolution of symptoms. Histology and intra-cystic PTH levels were consistent with a large parathyroid cyst however an alternative diagnosis of a 3rd branchial arch cyst could not be excluded. We discuss the prevalence and presentation of such cysts and different management options. This case illustrates a rare, yet important cause of a neck lump that can present with life-threatening upper airway obstruction.