Case Author(s): Charles Pringle/Henry Royal , 9/14/95 . Rating: #D1, #Q3
Diagnosis: parathyroid adenoma
Brief history:
Hyperparathyroidism status
post total thyroidectomy.
Images:
Anterior Neck (initial and 2 hour delayed images)
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View second image(us).
Ultrasound - transverse right lower neck
Full history/Diagnosis is available below
Diagnosis: parathyroid adenoma
Full history:
65-year old woman with primary
hyperparathyroidism status post total thyroidectomy,
now being evaluated for parathyroid adenoma.
Radiopharmaceutical:
Tc-99m Sestamibi
Findings:
Immediate static images of the
parathyroid scintigraphy reveal increased activity in
the inferior left thyroid bed and another focus of
increased activity at the medial aspect of the right
clavicle. The focus of activity at the medial aspect of
the right clavicle has persistently increased activity
on the 2-hour delayed images. This is consistent with
a parathyroid adenoma. The second focus of activity
in the region of the left inferior thyroid bed shows
gradually decreasing activity, most consistent with
residual thyroid.
Discussion:
Neck ultrasound also revealed an
area of residual soft tissue in the left thyroid bed with
an appearance most consistent with residual native
thyroid tissue. In the right neck inferiorly, there was
a hypoechoic mass immediately medial to the junction
of the common carotid artery and innominate artery.
The sonographic characteristics were most consistent
with a parathyroid lesion or, less likely, enlarged
lymph node.
Followup:
The patient underwent surgery on
7-3-95, at which time the right lower parathyroid
gland was removed. Pathology was consistent with a
parathyroid adenoma.
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: pa004
Copyright by Wash U MO
