甲状旁腺肿瘤的临床表现主要与高血钙（如肾结石、骨和肌肉疼痛）相关。然而，由于甲状旁腺瘤出血引起的颈部自发性出血是罕见的临床表现，其症状包括颈部疼痛性肿胀和瘀伤，伴随吞咽困难和呼吸困难。 我们报告了一例71岁女性患者的病例，患者出现急性颈部肿胀和大量出血，从颈部蔓延至腹部和两侧。患者的检查结果显示甲状旁腺激素水平升高和高血钙。颈部超声显示颈部两叶有甲状腺结节和右侧钻入性甲状腺肿。计算机断层扫描图像显示血肿从颈部右侧蔓延至纵隔。患者出现呼吸困难和血流动力学不稳定，需要进行紧急手术。术前的诊断是颈部出血，可能的原因是甲状腺结节破裂。然而，手术中确定出血源为位于上纵隔之下深处的右侧甲状旁腺肿瘤。患者的肿瘤组织病理学结果为甲状旁腺腺癌。根据我们的经验，当没有创伤史或手术史时，应将源自甲状旁腺肿瘤的出血列为急性颈部出血的原因。术后病理组织学分析对于检测甲状旁腺腺癌非常重要。©2023作者。

The clinical picture of parathyroid tumors is mainly related to hypercalcemia such as kidney stones and bone and muscle pain. However, spontaneous cervical hemorrhage due to parathyroidoma bleeding is rare with clinical manifestations of the painful swelling and bruising of the neck accompanied by dysphagia and dyspnea.We report a case of a 71-year-old female patient who presented with acute cervical swelling and extensive bleeding spreading from the neck to the abdomen and 2 flanks. Investigation of patients revealed increased parathyroid hormone levels and hypercalcemia. The neck ultrasound showed the thyroid nodules in 2 lobes, and goiter plongeant on the right. Computed tomography scan images showed a hematoma spreading from the right side of the neck to the mediastinum.The patient required emergency surgery due to dyspnea and hemodynamic instability. The preoperative diagnosis was cervical bleeding with the likely cause being thyroid nodule rupture. However, during the surgery, the bleeding source was determined to be the right parathyroid tumor located deeply below the superior mediastinum. The patient's histopathological result of the tumor is parathyroid adenocarcinoma.From our experience, the hemorrhage from parathyroid tumor should be considered as a cause of acute neck bleeding when no history of trauma or surgery is identified. Post-surgery histopathological analyses of the tumor are very important to detect parathyroid adenocarcinoma.© The Author(s) 2023.