Case Author(s): John Lahorra and Jerold Wallis , . Rating: #D2, #Q3

Diagnosis: Parathyroid adenoma

Brief history:

Elevated calcium


Initial and 2-hour delayed images

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Full history/Diagnosis is available below

Diagnosis: Parathyroid adenoma

Full history:

34 yo with persistant hyperthyroidism s/p 2 resections with removal of 2 parathyroid glands and right thyroid lobectomy


Tc-99m Sestamibi


Absent uptake is seen in the right thyroid lobe, consistent with prior resection. A large focus of increased uptake is seen in the superior mediastinum, which persists on delayed imaging.


Parathyroid adenomas can be found in the mediastinum. Imaging should include the chest (to the level of the myocardium), and just obtaining pinhole images of the thyroid region is not sufficient for the imaging study.

SPECT imaging or SPECT-CT would be helpful for localizing the depth of the adenoma, to aid in surgical planning. If separate CT is planned later, the level of the lesion can be marked on the skin after localizing it using a radioactive marker.


CT showed a homogeneously enhancing 2.3 x 3.5 cm mass which was retrosternally located and extended superiorly to the posteroinferior aspect of the left lobe of the thyroid and inferiorly to just above the level of the aortic arch. This was surgically resected.

ACR Codes and Keywords:

References and General Discussion of Parathyroid Scintigraphy (Anatomic field:Face, Mastoids, and Neck, Category:Neoplasm, Neoplastic-like condition)

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Case number: pa002

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