Primary hyperparathyroidism is a benign disease and is most often diagnosed during routine calcium measurement. It would be astonishing if a patient is symptomatic, but the diagnosis is neglected. A 56-year-old woman was admitted with complaint of localized pain in the chest wall following a regular bending and straightening. CXR showed a mass like lesion of the chest wall on the left and also bulged margin of the rib on the right side of the rib cage. Chest CT images revealed a dumbbell-shaped lesion of the rib on the right and an intramedulary mass on the rib on the left rib cage (brown tumor). Isotope bone scan showed an increased uptake in the skull, pelvis, spine, and ribs suggestive of osteomalacia. The main laboratory findings were: Ca=13.6 mg/dl, phosphorus=2.6mg/dl and PTH=633.6pg/ml. Sestamibi parathyroid scan revealed thyroid adenoma in the right lower lobe. Pathological lab tests confirmed parathyroid adenoma. Therefore, the patient was operated on. Four weeks after surgery, PTH level was 20pg/ml. Although most cases of hyperparathyroidism are patients with asymptomatic hypercalcaemia, it is important to have a good insight into diagnosing patients with localized and unexplained bone pain particularly because the pain may be felt in uncommon sites like the chest cavity.

Keywords: Hypercalcemia, Chest pain, Hyperparathyroidism

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