Ectopic parathyroids can often present a diagnostic and therapeutic conundrum for clinicians. Mediastinal parathyroid adenomas are usually small and located anteriorly within thymic tissue. To our knowledge, this is the first reported case of a large cystic parathyroid adenoma presenting as a 6-cm posterior mediastinal mass. After a successful thoracoscopic resection, parathyroid hormone levels normalized and the patient was discharged home on postoperative day 2.
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