Return to Case List with Diagnoses or Case List as Unknowns

PARATHYROID ADENOMA
Authored By: Keith Fischer and Shane Inoue.
Patient: 57 year old female
History: 57 year old female: with hyperparathyroidism with suspected parathyroid adenoma presents for imaging to localize a parathyroid adenoma.
Image Size:[small][as-submitted]

Fig. 1
Planar sestamibi images

Fig. 2
Coronal SPECT

Fig. 3

Fig. 4

Fig. 5

Fig. 6
Image Size:[small][as-submitted]

Findings: Nodular focus of increased activity just superior and lateral to the left lobe of the thyroid which could represent a parathyroid adenoma. However, this lesion demonstrates washout similar to thyroid on two-hour delay imaging and is therefore atypical in appearance for a parathyroid adenoma. Ultrasound performed at this facility today demonstrates a well circumscribed nodule in this region with sonographic findings characteristic for a parathyroid adenoma. As a result, this likely represents an ectopic parathyroid adenoma with atypical scintigraphic features.

U/S findings: Superior to the thyroid in the left neck adjacent to the carotid inferior to the level of the carotid bifurcation there is a hypoechoic solid lesion measuring 18.5 x 5.6 x 9.6 mm which shows marked vascularity on Doppler sonography. This likely represents a parathyroid adenoma, however, another possibility is that this is a lymph node.
DDx: Parathyroid adenoma
Parathyroid carcinoma
Thyroid adenoma
Thyroid carcinoma
Diagnosis: Operative findings: We found an undescended parathyroid just anterior and medial to the carotid well above the left thyroid lobe. It weighed 860 milligrams. Intraoperative
PTH went from 1807 pg/ml basal to 33 pg/ml 11 minutes after the adenoma was
removed.

Pathology: PARATHYROID, LEFT, EXCISION- HYPERCELLULAR PARATHYROID
General Discussion: The diagnosis of parathyroid tumor with Tc-99m sestamibi scintigraphy is based on the differential washout rate between the thyroid and diseased parathyroids. The parathyroid, in general, retains the activity while the activity washes out of the thyroid.
Rapid washout from parathyroid adenoma has been described in case reports, however.
References: Thank you to Ferenc Czeyda-Pommersheim, MD for contributing this case.

Bénard F, Lefebvre B, Beuvon F, Langlois MF, Bisson G. Rapid wash-out of technetium-99m-MIBI from a large parathyroid adenoma. J Nucl Med. Vol. 36, pp. 241–243
Leslie WD, Riese KT, Dupont JO, Teterdy AE. Parathyroid adenomas without sestamibi retention. Clin Nucl Med. Vol. 20, pp. 699–702
Nguyen. Parathyroid Imaging with Tc-99m Sestamibi Planar and SPECT Scintigraphy. Radiographics. 1999;19:601-614.
Comments:
No comments posted.
Additional Details:

Case Number: 131024Owner(s): Keith Fischer and Shane InoueLast Updated: 02-07-2013
Anatomy: Face and Neck   Pathology: Neoplasm
Modality: MR, USAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: parathyroid adenoma

Case has been viewed 24 times.

The reader is fully responsible for confirming the accuracy of this content.
Text and images may be copyrighted by the case author or institution.