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Parathyroid cysts are relatively rare lesions of the neck, usually millimetric in size and without clinical consequences. By contrast, macrocystic forms require additional investigations and often treatment. A cervical hematoma caused by a ruptured parathyroid cyst is extremely rare and usually occurs due to cystic degeneration of an adenoma. We present the case of a male patient with spontaneous cervical hematoma caused by a ruptured parathyroid cyst with rapidly evolving and severe compressive manifestations occurring after an episode of upper respiratory infection. Differential diagnosis is difficult, especially under emergency conditions, and chirugical treatment should not be delayed.