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Case History

Case History. 70/F , Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented with Hypercalcemic crisis (Coma- 2 months back), Persistent nausea & Vomiting Evaluated. Very High Calcium & PTH. Biochemistry.

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Case History

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  1. Case History • 70/F , Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month • Presented with Hypercalcemic crisis (Coma- 2 months back), Persistent nausea & Vomiting • Evaluated

  2. Very High Calcium & PTH

  3. Biochemistry

  4. Hypercalcemic crisis managed medically

  5. Concordant USG & Sestamibi Findings

  6. Sestamibi Scan

  7. USG: Showed a Single Right adenoma

  8. Anaesthetist view

  9. Cardiologist Opinion: Very High surgical risk for Cardiac events Transfused 1 pint of Packed RBCS the day before Surgery

  10. Positioning

  11. Plane between straps and sternocleidomastoid(SCM) muscle right side SCM Straps

  12. Parathyroid visulaisation Parathyroid tumor SCM

  13. Visulalisation of both Parathyroid tumors Superior Inferior

  14. Double Parathyroid adenomas Superior Inferior Thyroid

  15. Tumor bed after removal of both Parathyroid tumors,Wound Closed without a drain Thyroid

  16. Surgical Specimen

  17. Closer view of the Double adenomas Superior: 3.2x2.7x1.1cm Weight 8.2 gms Inferior: 4.2x 3.1x2.6cm Weight 14.6 gms

  18. Post op Patient did not develop symptomatic hypocalcemia, Voice normal, Wound healthy discharged with Oral Calcium & vitamin D supplements

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