Case Author(s): J. Wallis , 8/4/94 . Rating: #D3, #Q3

Diagnosis: Mediastinal parathyroid adenoma

Brief history:

Patient with elevated calcium levels.


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Full history/Diagnosis is available below

Diagnosis: Mediastinal parathyroid adenoma

Full history:

The patient has had neck exploration for a suspected parathyroid adenoma, with removal of one normal size parathyroid gland. He has persistantly elevated calcium levels.


The patient was imaged with Tc-99m Sestamibi. Initial images show normal uptake in the thyroid gland, heart, liver, and bowel; in addition there is a focus of uptake in the mediastinum. Delayed images show normal washout of tracer from the thyroid gland, without a persistant focus in the thyroid bed to suggest a parathyroid adenoma. However, the mediastinal focus is again seen.


The findings suggest an ectopic parathyroid adenoma in the mediastinum.


A marker was placed over the site of mediastinal uptake, and subsequent CT imaging confirmed a 1 cm enhancing nodule in the anterior aspect of the superior mediastinum suggesting a parathyroid adenoma. The parathyroid adenoma was resected surgically.

Major teaching point(s):

1) Images for parathyroid adenomas should include views of the chest and mediastinum as well as the neck.

2) Sestamibi is a useful agent for parathyroid imaging. When imaging non-ectopic parathyroid adenomas, the slower washout of tracer from parathyroid tissue compared to normal thyroid tissue aids in identification of adenomas.

ACR Codes and Keywords:

References and General Discussion of Parathyroid Scintigraphy (Anatomic field:Lung, Mediastinum, and Pleura, Category:Neoplasm, Neoplastic-like condition)

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Case number: pa001

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