Dr Alka Singhal - Academia.edu (original) (raw)
Papers by Dr Alka Singhal
World Journal of Endocrine Surgery
Aim and objective: To evaluate the incidence of various locations of enlarged eutopic and ectopic... more Aim and objective: To evaluate the incidence of various locations of enlarged eutopic and ectopic parathyroids in patients of hyperparathyroidism, their imaging features, diagnosis, and surgical confirmation. Materials and methods: A retrospective study conducted at a tertiary institution, where 400 patients operated for hyperparathyroidism from 2012 to 2017 was analyzed. Diagnostic findings of Tc-99m-sestamibi scan and ultrasound were compared with surgical findings and subsequent histopathology. Contrast CT(4D CT) was utilized only in select cases. Results: Of 400 patients single adenoma was seen in 350 patients (87.5%), two or more nodules in 41 patients (10.2%), and carcinoma in 3 cases. Of the 350 solitary adenomas, 291 were juxtaposed to thyroid (83.1%), and ectopic in 59 (16.8%) cases. Ectopic along the thymic tract in 38 cases (10.8%), upper mediastinum 8 cases (2.2%), angle of jaw in 2 cases (0.5%), carotid sheath 2 cases (0.5 %),retroesophageal 2 cases (0.5%) and intrathyroidal in 7 cases (2%). Tc-99m-sestamibi scan was positive in localizing parathyroid nodules in 297 (84.8%) cases, and ultrasound in 339 (96.8%) cases. Of the nodules localized by Tc-99m-sestamibi scan, 82% were true and 3% were false localization at the surgery. Nodules localized by ultrasound were true in 99% and false in 1% cases. Ultrasound localized the nodules in sestamibi negative cases in 12% of patients. Conclusion: Identification of enlarged parathyroids and their differentiation from thyroid nodules and other neck lesions is the key role of imaging. Ultrasound is complimentary to Tc-99m-sestamibi scan and offers significant value addition by precision anatomical localization, characterization and finding additional nodules. Using two imaging modalities of Tc-99m-sestamibi scan and ultrasound, the diagnostic sensitivity is 99% and specificity is 98%. Clinical significance: Localization of all the abnormal parathyroid glands in hyperparathyroidism remains a diagnostic challenge on account of both sensitivity and specificity of the available imaging modalities, as well as anatomical variations in the location of the parathyroid glands. A thorough knowledge of the anatomy, embryology along with the merits and pitfalls of the various available imaging modalities is essential to make an accurate preoperative diagnosis and avoid revision surgeries. Keypoints: • Parathyroid glands are ectopic in 16.8% cases. • Technetium Tc-99m-sestamibi localizes the parathyroid nodules in 85% cases. • Ultrasound detects parathyroid nodules in additional sestamibi negative cases (12%). • Ultrasound gives precise anatomical localization of parathyroid nodules. • With both MIBI and ultrasound, the diagnostic sensitivity is 99% and specificity is 98%.
Indian Journal of Radiology and Imaging
Parathyroid cyst is a rare clinical entity and often presents as a diagnostic challenge, especial... more Parathyroid cyst is a rare clinical entity and often presents as a diagnostic challenge, especially when presents in conjunction with a coexistent parathyroid adenoma. Patient with primary hyperparathyroidism had presented with a localised left inferior parathyroid adenoma with a coexistent right inferior parathyroid cyst which was initially missed on routine ultrasound and sestamibi scan. Suspicion of right inferior thyroid cyst was raised on ultrasound done by a dedicated parathyroid ultrasonologist. Right inferior thyroid cyst was confirmed to be parathyroid cyst on histopathological examination. Parathyroid cysts are seldom picked on sestamibi due to compressed parathyroid tissue present only at the periphery of the cyst. Hence, use of adjunct anatomical imaging like ultrasound, CT scan or MRI is worthwhile to reduce chances of missing hyperfunctional parathyroid tissue, which can eventually lead to revision surgery for persistent primary hyperparathyroidism.
Ultrasound in Medicine & Biology, 2017
Objectives: To assess the characteristics and interval change in N and non-N SAT using follow-up ... more Objectives: To assess the characteristics and interval change in N and non-N SAT using follow-up US. Methods: From January 2008 to December 2014, 85 patients who were clinically suspected of SAT underwent US by a single radiologist. SAT was confirmed on the basis of clinical, US, and pathological findings. In the initial and follow-up US, we investigated the US findings and interval change in N and non-N SAT lesions. The interval change for a SAT lesion was classified: disappeared, decreased, increased, negative fluctuation, positive fluctuation, and no interval change. Results: Of 85 patients, 64 (75.3%) were confirmed as SAT. In 64 SAT patients, the prevalence of N (n 5 39) and non-N (n 5 35) lesions was similar; 10 patients exhibited both N and non-N lesions. There was a significant difference in contour, echogenicity, and shape between N and non-N SAT lesions (p 5 0.010, p ,0.0001, p 5 0.014), whereas no significant difference in margin and vascularity (p 5 0.090, p 5 0.302). Of 64 patients, 41 underwent follow-up US. In both N and non-N lesions, the common interval change included disappeared (43.3%, 55.6%), decreased (26.7%, 22.2%), and negative fluctuation (10%, 16.7%), whereas increased change was found only in 4 N lesions (13.3%). The rate of no interval change was similar in N and non-N lesions (6.7%, 5.6%). Conclusions: There was no significant difference in the interval change between N and non-N SAT lesions, although there was a significant difference in contour, echogenicity, and shape.
Indian Journal of Nuclear Medicine
We report here a case of unusually large brown tumor of mandible mimicking cherubism in a patient... more We report here a case of unusually large brown tumor of mandible mimicking cherubism in a patient with secondary hyperparathyroidism (HPT). The patient is a young male with a large head and a protruding jaw with an open mouth appearance. Initial clinical appearance looked like cherubism. However further clinical, biochemical, and radiological evaluation revealed a large brown tumor in a case of prolonged secondary HPT, which was confirmed on histopathology. All of the typical advanced radiological features of HPT were noted, highlighting the severity of progression of the disease. This case emphasizes the need for surveillance of serum calcium levels on routine biochemical investigations as to enable an early diagnosis of HPT. With timely proper management, such cases should be on the decline in the future.
Journal of Head & Neck Physicians and Surgeons
Intrathyroidal parathyroid (IP) adenoma as a cause of primary hyperparathyroidism (PHPT) presents... more Intrathyroidal parathyroid (IP) adenoma as a cause of primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localization and differentiating it from a thyroid nodule. We report here three distinct cases of PHPT where preoperative imaging findings were compared with surgical and histopathological findings. Case 1 was a typical true IP adenoma, as diagnosed by preoperative sestamibi and ultrasound, and confirmed at surgery and subsequent histopathology. Case 2 was diagnosed by sestamibi and ultrasound as bilateral lower pole IP adenomas which turned out to be thyroid nodules at surgery. Postsurgery, the serum PTH levels dropped only partially and PHPT persisted. Revision surgery was performed, and a right inferior parathyroid adenoma was removed, after which PTH was normalized. Case 3 had a preoperative sestamibi diagnosis of left inferior parathyroid. Preoperative ultrasound suggested a left thyroid nodule/IP along with an associated contralateral right inferior parathyroid nodule. Surgery and subsequent histopathology confirmed left follicular adenoma and right inferior parathyroid adenoma. We discuss the limitations of preoperative imaging modalities in these cases along with their learning outcomes. It is very essential that all the involved clinicians, radiologists, and surgeons are well aware of the diagnostic features and pitfalls associated with IPs so as to enable a correct diagnosis and appropriate surgical or medical management.
Journal of Head & Neck Physicians and Surgeons
We report here a case of left ectopic undescended parathyroid nodule located high in the neck, at... more We report here a case of left ectopic undescended parathyroid nodule located high in the neck, at the angle of jaw which was diagnosed primarily on high-resolution color Doppler ultrasound imaging at our institution, followed by Sestamibi and computed tomography-single photon emission computed tomography (CT-SPECT) and surgery. A 41-year-old female having endometrial hyperplasia and planned for TAH + BSO. Her routine preoperative investigations showed serum calcium to be 13.0 mg/dL. Serum parathyroid hormone (PTH) was 914.6 pg/mL and 25–OH Vitamin D 8.0 g/mL. Ultrasound neck with color Doppler localized an ectopic undescended left parathyroid adenoma located high in the neck just adjacent to the left submandibular gland. Sestamibi was suggestive of the left ectopic undescended parathyroid adenoma (below the pole of the left submandibular gland), confirmed further on CT-SPECT. The patient was operated and a 30 mm × 23 mm × 10 mm sized parathyroid adenoma was removed and confirmed on histopathology. A dedicated high-resolution color Doppler ultrasound has a great potential to localize the parathyroid nodules in all cases of raised serum PTH and must be utilized in all cases along with other imaging modalities.
Indian Journal of Endocrinology and Metabolism, 2016
Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach o... more Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach of parathyroidectomy. Aim: To describe clinical and biochemical profile, evaluate preoperative imaging modalities and surgical approach in patients with primary hyperparathyroidism (PHPT). Methodology: This was a retrospective study conducted at the single institution. All patients who underwent evaluation and surgery for PHPT from 2011 to 2015 were included in the study. Results: A total of 100 patients underwent surgery for PHPT. Mean (standard deviation) age was 51.6 (15.9) years with female to male ratio of 1.7:1. Forty patients had severe symptoms, and sixty had mild to moderate symptoms. The sensitivity of technetium-99m hexakis (2-methoxyisobutylisonitrile) (MIBI) scan and ultrasonography (USG) neck in identifying abnormal parathyroid gland was 93% (93/100) and 98% (98/100), respectively. The MIBI scan results of 90/93 (96.7%) patients corresponded with their surgical findings whereas preoperative USG findings of 96/98 patients (98%) showed correlation with operative findings. Intraoperative intact parathyroid hormone (IOPTH) levels at 10 min postexcision were measured in forty patients (minimally invasive parathyroidectomy = 38, bilateral neck exploration = 1, and unilateral neck exploration = 1). All patients except two had <50% fall in IOPTH. Adenoma weight was positively correlated with preoperative intact PTH. Conclusion: We found that USG has higher sensitivity (98%) than MIBI scan (93%) in localizing abnormal parathyroid gland. Moreover, USG had a higher preoperative localization accuracy (93%) than MIBI scan (90%), allowing to choose an appropriate surgical approach. A higher proportion of patients (60%) had mild/asymptomatic form of PHPT.
Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach o... more Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach of parathyroidectomy. Aim: To describe clinical and biochemical profile, evaluate preoperative imaging modalities and surgical approach in patients with primary hyperparathyroidism (PHPT). Methodology: This was a retrospective study conducted at the single institution. All patients who underwent evaluation and surgery for PHPT from 2011 to 2015 were included in the study. Results: A total of 100 patients underwent surgery for PHPT. Mean (standard deviation) age was 51.6 (15.9) years with female to male ratio of 1.7:1. Forty patients had severe symptoms, and sixty had mild to moderate symptoms. The sensitivity of technetium-99m hexakis (2-methoxyisobutylisonitrile) (MIBI) scan and ultrasonography (USG) neck in identifying abnormal parathyroid gland was 93% (93/100) and 98% (98/100), respectively. The MIBI scan results of 90/93 (96.7%) patients corresponded with their surgical findings whereas preoperative USG findings of 96/98 patients (98%) showed correlation with operative findings. Intraoperative intact parathyroid hormone (IOPTH) levels at 10 min postexcision were measured in forty patients (minimally invasive parathyroidectomy = 38, bilateral neck exploration = 1, and unilateral neck exploration = 1). All patients except two had <50% fall in IOPTH. Adenoma weight was positively correlated with preoperative intact PTH. Conclusion: We found that USG has higher sensitivity (98%) than MIBI scan (93%) in localizing abnormal parathyroid gland. Moreover, USG had a higher preoperative localization accuracy (93%) than MIBI scan (90%), allowing to choose an appropriate surgical approach. A higher proportion of patients (60%) had mild/asymptomatic form of PHPT.
ABSTRACT We report here a case of left ectopic undescended parathyroid nodule located high in the... more ABSTRACT
We report here a case of left ectopic undescended parathyroid nodule located high in the neck, at the angle of jaw which was diagnosed
primarily on high‑resolution color Doppler ultrasound imaging at our institution, followed by Sestamibi and computed tomography‑single
photon emission computed tomography (CT‑SPECT) and surgery. A 41‑year‑old female having endometrial hyperplasia and planned
for TAH + BSO. Her routine preoperative investigations showed serum calcium to be 13.0 mg/dL. Serum parathyroid hormone (PTH)
was 914.6 pg/mL and 25–OH Vitamin D 8.0 g/mL. Ultrasound neck with color Doppler localized an ectopic undescended left
parathyroid adenoma located high in the neck just adjacent to the left submandibular gland. Sestamibi was suggestive of the left
ectopic undescended parathyroid adenoma (below the pole of the left submandibular gland), confirmed further on CT‑SPECT. The
patient was operated and a 30 mm × 23 mm × 10 mm sized parathyroid adenoma was removed and confirmed on histopathology.
A dedicated high‑resolution color Doppler ultrasound has a great potential to localize the parathyroid nodules in all cases of raised
serum PTH and must be utilized in all cases along with other imaging modalities.
Key words: Ectopic undescended, hyperparathyroidism, parathyroid adenoma, ultrasound neck with color Doppler
World Journal of Endocrine Surgery
Aim and objective: To evaluate the incidence of various locations of enlarged eutopic and ectopic... more Aim and objective: To evaluate the incidence of various locations of enlarged eutopic and ectopic parathyroids in patients of hyperparathyroidism, their imaging features, diagnosis, and surgical confirmation. Materials and methods: A retrospective study conducted at a tertiary institution, where 400 patients operated for hyperparathyroidism from 2012 to 2017 was analyzed. Diagnostic findings of Tc-99m-sestamibi scan and ultrasound were compared with surgical findings and subsequent histopathology. Contrast CT(4D CT) was utilized only in select cases. Results: Of 400 patients single adenoma was seen in 350 patients (87.5%), two or more nodules in 41 patients (10.2%), and carcinoma in 3 cases. Of the 350 solitary adenomas, 291 were juxtaposed to thyroid (83.1%), and ectopic in 59 (16.8%) cases. Ectopic along the thymic tract in 38 cases (10.8%), upper mediastinum 8 cases (2.2%), angle of jaw in 2 cases (0.5%), carotid sheath 2 cases (0.5 %),retroesophageal 2 cases (0.5%) and intrathyroidal in 7 cases (2%). Tc-99m-sestamibi scan was positive in localizing parathyroid nodules in 297 (84.8%) cases, and ultrasound in 339 (96.8%) cases. Of the nodules localized by Tc-99m-sestamibi scan, 82% were true and 3% were false localization at the surgery. Nodules localized by ultrasound were true in 99% and false in 1% cases. Ultrasound localized the nodules in sestamibi negative cases in 12% of patients. Conclusion: Identification of enlarged parathyroids and their differentiation from thyroid nodules and other neck lesions is the key role of imaging. Ultrasound is complimentary to Tc-99m-sestamibi scan and offers significant value addition by precision anatomical localization, characterization and finding additional nodules. Using two imaging modalities of Tc-99m-sestamibi scan and ultrasound, the diagnostic sensitivity is 99% and specificity is 98%. Clinical significance: Localization of all the abnormal parathyroid glands in hyperparathyroidism remains a diagnostic challenge on account of both sensitivity and specificity of the available imaging modalities, as well as anatomical variations in the location of the parathyroid glands. A thorough knowledge of the anatomy, embryology along with the merits and pitfalls of the various available imaging modalities is essential to make an accurate preoperative diagnosis and avoid revision surgeries. Keypoints: • Parathyroid glands are ectopic in 16.8% cases. • Technetium Tc-99m-sestamibi localizes the parathyroid nodules in 85% cases. • Ultrasound detects parathyroid nodules in additional sestamibi negative cases (12%). • Ultrasound gives precise anatomical localization of parathyroid nodules. • With both MIBI and ultrasound, the diagnostic sensitivity is 99% and specificity is 98%.
Indian Journal of Radiology and Imaging
Parathyroid cyst is a rare clinical entity and often presents as a diagnostic challenge, especial... more Parathyroid cyst is a rare clinical entity and often presents as a diagnostic challenge, especially when presents in conjunction with a coexistent parathyroid adenoma. Patient with primary hyperparathyroidism had presented with a localised left inferior parathyroid adenoma with a coexistent right inferior parathyroid cyst which was initially missed on routine ultrasound and sestamibi scan. Suspicion of right inferior thyroid cyst was raised on ultrasound done by a dedicated parathyroid ultrasonologist. Right inferior thyroid cyst was confirmed to be parathyroid cyst on histopathological examination. Parathyroid cysts are seldom picked on sestamibi due to compressed parathyroid tissue present only at the periphery of the cyst. Hence, use of adjunct anatomical imaging like ultrasound, CT scan or MRI is worthwhile to reduce chances of missing hyperfunctional parathyroid tissue, which can eventually lead to revision surgery for persistent primary hyperparathyroidism.
Ultrasound in Medicine & Biology, 2017
Objectives: To assess the characteristics and interval change in N and non-N SAT using follow-up ... more Objectives: To assess the characteristics and interval change in N and non-N SAT using follow-up US. Methods: From January 2008 to December 2014, 85 patients who were clinically suspected of SAT underwent US by a single radiologist. SAT was confirmed on the basis of clinical, US, and pathological findings. In the initial and follow-up US, we investigated the US findings and interval change in N and non-N SAT lesions. The interval change for a SAT lesion was classified: disappeared, decreased, increased, negative fluctuation, positive fluctuation, and no interval change. Results: Of 85 patients, 64 (75.3%) were confirmed as SAT. In 64 SAT patients, the prevalence of N (n 5 39) and non-N (n 5 35) lesions was similar; 10 patients exhibited both N and non-N lesions. There was a significant difference in contour, echogenicity, and shape between N and non-N SAT lesions (p 5 0.010, p ,0.0001, p 5 0.014), whereas no significant difference in margin and vascularity (p 5 0.090, p 5 0.302). Of 64 patients, 41 underwent follow-up US. In both N and non-N lesions, the common interval change included disappeared (43.3%, 55.6%), decreased (26.7%, 22.2%), and negative fluctuation (10%, 16.7%), whereas increased change was found only in 4 N lesions (13.3%). The rate of no interval change was similar in N and non-N lesions (6.7%, 5.6%). Conclusions: There was no significant difference in the interval change between N and non-N SAT lesions, although there was a significant difference in contour, echogenicity, and shape.
Indian Journal of Nuclear Medicine
We report here a case of unusually large brown tumor of mandible mimicking cherubism in a patient... more We report here a case of unusually large brown tumor of mandible mimicking cherubism in a patient with secondary hyperparathyroidism (HPT). The patient is a young male with a large head and a protruding jaw with an open mouth appearance. Initial clinical appearance looked like cherubism. However further clinical, biochemical, and radiological evaluation revealed a large brown tumor in a case of prolonged secondary HPT, which was confirmed on histopathology. All of the typical advanced radiological features of HPT were noted, highlighting the severity of progression of the disease. This case emphasizes the need for surveillance of serum calcium levels on routine biochemical investigations as to enable an early diagnosis of HPT. With timely proper management, such cases should be on the decline in the future.
Journal of Head & Neck Physicians and Surgeons
Intrathyroidal parathyroid (IP) adenoma as a cause of primary hyperparathyroidism (PHPT) presents... more Intrathyroidal parathyroid (IP) adenoma as a cause of primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localization and differentiating it from a thyroid nodule. We report here three distinct cases of PHPT where preoperative imaging findings were compared with surgical and histopathological findings. Case 1 was a typical true IP adenoma, as diagnosed by preoperative sestamibi and ultrasound, and confirmed at surgery and subsequent histopathology. Case 2 was diagnosed by sestamibi and ultrasound as bilateral lower pole IP adenomas which turned out to be thyroid nodules at surgery. Postsurgery, the serum PTH levels dropped only partially and PHPT persisted. Revision surgery was performed, and a right inferior parathyroid adenoma was removed, after which PTH was normalized. Case 3 had a preoperative sestamibi diagnosis of left inferior parathyroid. Preoperative ultrasound suggested a left thyroid nodule/IP along with an associated contralateral right inferior parathyroid nodule. Surgery and subsequent histopathology confirmed left follicular adenoma and right inferior parathyroid adenoma. We discuss the limitations of preoperative imaging modalities in these cases along with their learning outcomes. It is very essential that all the involved clinicians, radiologists, and surgeons are well aware of the diagnostic features and pitfalls associated with IPs so as to enable a correct diagnosis and appropriate surgical or medical management.
Journal of Head & Neck Physicians and Surgeons
We report here a case of left ectopic undescended parathyroid nodule located high in the neck, at... more We report here a case of left ectopic undescended parathyroid nodule located high in the neck, at the angle of jaw which was diagnosed primarily on high-resolution color Doppler ultrasound imaging at our institution, followed by Sestamibi and computed tomography-single photon emission computed tomography (CT-SPECT) and surgery. A 41-year-old female having endometrial hyperplasia and planned for TAH + BSO. Her routine preoperative investigations showed serum calcium to be 13.0 mg/dL. Serum parathyroid hormone (PTH) was 914.6 pg/mL and 25–OH Vitamin D 8.0 g/mL. Ultrasound neck with color Doppler localized an ectopic undescended left parathyroid adenoma located high in the neck just adjacent to the left submandibular gland. Sestamibi was suggestive of the left ectopic undescended parathyroid adenoma (below the pole of the left submandibular gland), confirmed further on CT-SPECT. The patient was operated and a 30 mm × 23 mm × 10 mm sized parathyroid adenoma was removed and confirmed on histopathology. A dedicated high-resolution color Doppler ultrasound has a great potential to localize the parathyroid nodules in all cases of raised serum PTH and must be utilized in all cases along with other imaging modalities.
Indian Journal of Endocrinology and Metabolism, 2016
Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach o... more Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach of parathyroidectomy. Aim: To describe clinical and biochemical profile, evaluate preoperative imaging modalities and surgical approach in patients with primary hyperparathyroidism (PHPT). Methodology: This was a retrospective study conducted at the single institution. All patients who underwent evaluation and surgery for PHPT from 2011 to 2015 were included in the study. Results: A total of 100 patients underwent surgery for PHPT. Mean (standard deviation) age was 51.6 (15.9) years with female to male ratio of 1.7:1. Forty patients had severe symptoms, and sixty had mild to moderate symptoms. The sensitivity of technetium-99m hexakis (2-methoxyisobutylisonitrile) (MIBI) scan and ultrasonography (USG) neck in identifying abnormal parathyroid gland was 93% (93/100) and 98% (98/100), respectively. The MIBI scan results of 90/93 (96.7%) patients corresponded with their surgical findings whereas preoperative USG findings of 96/98 patients (98%) showed correlation with operative findings. Intraoperative intact parathyroid hormone (IOPTH) levels at 10 min postexcision were measured in forty patients (minimally invasive parathyroidectomy = 38, bilateral neck exploration = 1, and unilateral neck exploration = 1). All patients except two had <50% fall in IOPTH. Adenoma weight was positively correlated with preoperative intact PTH. Conclusion: We found that USG has higher sensitivity (98%) than MIBI scan (93%) in localizing abnormal parathyroid gland. Moreover, USG had a higher preoperative localization accuracy (93%) than MIBI scan (90%), allowing to choose an appropriate surgical approach. A higher proportion of patients (60%) had mild/asymptomatic form of PHPT.
Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach o... more Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach of parathyroidectomy. Aim: To describe clinical and biochemical profile, evaluate preoperative imaging modalities and surgical approach in patients with primary hyperparathyroidism (PHPT). Methodology: This was a retrospective study conducted at the single institution. All patients who underwent evaluation and surgery for PHPT from 2011 to 2015 were included in the study. Results: A total of 100 patients underwent surgery for PHPT. Mean (standard deviation) age was 51.6 (15.9) years with female to male ratio of 1.7:1. Forty patients had severe symptoms, and sixty had mild to moderate symptoms. The sensitivity of technetium-99m hexakis (2-methoxyisobutylisonitrile) (MIBI) scan and ultrasonography (USG) neck in identifying abnormal parathyroid gland was 93% (93/100) and 98% (98/100), respectively. The MIBI scan results of 90/93 (96.7%) patients corresponded with their surgical findings whereas preoperative USG findings of 96/98 patients (98%) showed correlation with operative findings. Intraoperative intact parathyroid hormone (IOPTH) levels at 10 min postexcision were measured in forty patients (minimally invasive parathyroidectomy = 38, bilateral neck exploration = 1, and unilateral neck exploration = 1). All patients except two had <50% fall in IOPTH. Adenoma weight was positively correlated with preoperative intact PTH. Conclusion: We found that USG has higher sensitivity (98%) than MIBI scan (93%) in localizing abnormal parathyroid gland. Moreover, USG had a higher preoperative localization accuracy (93%) than MIBI scan (90%), allowing to choose an appropriate surgical approach. A higher proportion of patients (60%) had mild/asymptomatic form of PHPT.
ABSTRACT We report here a case of left ectopic undescended parathyroid nodule located high in the... more ABSTRACT
We report here a case of left ectopic undescended parathyroid nodule located high in the neck, at the angle of jaw which was diagnosed
primarily on high‑resolution color Doppler ultrasound imaging at our institution, followed by Sestamibi and computed tomography‑single
photon emission computed tomography (CT‑SPECT) and surgery. A 41‑year‑old female having endometrial hyperplasia and planned
for TAH + BSO. Her routine preoperative investigations showed serum calcium to be 13.0 mg/dL. Serum parathyroid hormone (PTH)
was 914.6 pg/mL and 25–OH Vitamin D 8.0 g/mL. Ultrasound neck with color Doppler localized an ectopic undescended left
parathyroid adenoma located high in the neck just adjacent to the left submandibular gland. Sestamibi was suggestive of the left
ectopic undescended parathyroid adenoma (below the pole of the left submandibular gland), confirmed further on CT‑SPECT. The
patient was operated and a 30 mm × 23 mm × 10 mm sized parathyroid adenoma was removed and confirmed on histopathology.
A dedicated high‑resolution color Doppler ultrasound has a great potential to localize the parathyroid nodules in all cases of raised
serum PTH and must be utilized in all cases along with other imaging modalities.
Key words: Ectopic undescended, hyperparathyroidism, parathyroid adenoma, ultrasound neck with color Doppler