Ectopic mediastinal parathyroid adenoma (original) (raw)
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Localization and management of mediastinal parathyroid adenoma – a case report
IMC journal of medical science, 2022
Ectopic parathyroid adenoma sometimes poses diagnostic challenge and can be a cause of persistent and recurrent primary hyperparathyroidism. Anterior mediastinum is one of the locations for ectopic parathyroid adenoma. Surgical excision is the only cure and for successful surgery, pre-operative localization is crucial. Chance of failed surgery is being increased without prior localization of the ectopic gland. The combination of single photon emission computed tomography (SPECT) and computed tomography (CT) has got high sensitivity for accurate localization of ectopic parathyroid. On the other hand, with accurate localization surgical outcome is excellent. Here we report, successful localization and management of a case of primary hyperparathyroidism due to adenoma in anterior mediastinum in 47-year-old man.
Unusual Ectopic Parathyroid Adenoma: A Case Report
Acta medica Iranica, 2016
An ectopically placed parathyroid in the mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism. They are rarely in a huge size. We report a case of a 70-year-old man with a history of total parathyroidectomy and thymectomy presented with a lack of appetite, nausea, and generalized bone pain, polydipsia and a calcium level of 14.4 mg/dl. 99mTc-sestamibi scintigraphy with single-photon emission computerized tomography (SPECT) showed a focal zone of radiotracer accumulation in the midline of anterior chest wall (xiphoid level). The mass excised from our patient surgically was 75 grams. This weight and location of the tumor is a very rare finding in parathyroid adenomas.
Ectopic parathyroid adenoma localised with sestamibi SPECT and image-fused computed tomography
The Medical journal of Australia, 2003
Confident localisation of ectopic parathyroid adenomas, particularly those outside the neck, can be difficult. Even preoperative radiological imaging may not be helpful, as there are few characteristic findings. We report a case in which hyperfunctioning ectopic parathyroid tissue in the mediastinum was detected with technetium-99m-sestamibi single-photon emission computed tomography and accurately localised non-invasively with image-fused computed tomography. This technique directly modified management.
Case Report Mediastinal Parathyroid Adenoma
2015
An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recur-rent primary hyperparathyroidism (PHPT) and is recog-nized as an important cause of failed primary neck explo-ration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first exploration whereas in the 3rd case, it was successfully removed with mediastinal exploration after 2 failed neck explorations. In established cases of PHPT with equivocal preoperative localization studies or negative neck explo-rations, an ectopically placed parathyroid adenoma should be considered and once localized, should be surgically removed for cure.
We present a 31-year old male patient with primary hyperparathyroidism (PHPT), complicated by obstructive uropathy due to a staghorn calculus. He had minimally invasive right lower pole parathyroidectomy (MIP), following localization in the right lower pole of the parathyroid gland, on ultrasound. Postsurgical histology confirmed it to be a lymph node. The serum calcium and PTH levels remained elevated post-operative. Tc-99m methoxyisobutyl isonitrile (Sestamibi) planar imaging showed a focus of uptake superior to the upper pole of the right thyroid gland, that was localized lateral to the right true vocal cord on SPECT/CT. Post-operative histology confirmed a parathyroid adenoma.
Ectopic mediastinal parathyroid adenoma localized with four-dimensional CT: a case report
Radiology case reports, 2017
We present a case of an ectopic mediastinal parathyroid adenoma in a 58-year-old male patient. We show how different imaging modalities were successfully used to reach a diagnosis. We particularly focus on the role of four-dimensional CT scan in preoperative localization of ectopic adenomas and discuss how diverse imaging modalities can be integrated in the workup of ectopic parathyroid adenomas.
Parathyroid adenoma detected with 99mTc-tetrofosmin dual-phase scintigraphy: a case report
BMC Research Notes, 2014
Background: Tc-sestamibi is the most frequently used radionuclide agent for the detection of parathyroid adenomas in the clinical setting. However, Tc-tetrofosmin is another such agent that may be used for this purpose. This case report presents the significance and practicality of 99m Tc-tetrofosmin for the diagnosis of parathyroid adenomas with probable high p-glycoprotein levels. Case presentation: A 45-year-old woman was referred to our Nuclear Department with a palpable neck nodule suspicious for parathyroid adenoma. She had no significant medical history or other accompanying symptoms. Blood examination results were normal with the exception of the parathormone level which was high at 167.2 pg/ml. Neck ultrasonography revealed a hypoechoic mass near the lower pole of the thyroid gland. 99m Tc-tetrofosmin dual-phase scintigraphy with early and delayed images was performed and the results supported the presupposition of parathyroid adenoma as shown by increased radiopharmaceutical levels near the lower left thyroid gland on the early image that disappeared on the delayed image. Moreover, TcO 4 -thyroid scintigraphy results excluded thyroid pathology. Two months after the diagnosis, parathyroidectomy was successfully performed without postoperative complications. The pathology report and clinical response to a gradual decrease of parathormone confirmed the initial diagnosis. We strongly recommend the use of reverse 99m Tc-tetrofosmin scintigraphy as a useful and safe examination technique for the diagnosis of parathyroid adenomas.
International Journal of Surgery Case Reports, 2018
INTRODUCTION: Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by pathologic growth of one or more of the parathyroid glands. Parathyroidectomies (PTX) in patients with PHPT are procedures with low morbidity, few complications, and a high cure rate. However, the parathyroid glands may be found at various anatomical locations and occasionally they are intrathoracic. CASE PRESENTATION: We present a 57-year-old patient with PHPT. Before the first and second operation, the preoperative imaging indicated pathologic parathyroid tissue in the neck. Due to postoperative persistent hypercalcemia we performed a 11C-methionine positron emission tomography (11C-MET-PET/CT). The scan showed a focus with increased activity in the mediastinum. Due to persistent disease, an ectopic parathyroid gland in the mediastinum was suspected. At a third operation, the parathyroid adenoma was resected through an anterolateral thoracotomy. Biochemical values normalized and bone mineral density improved postoperatively. Hence, an ectopic localization of a parathyroid gland should be considered during the preoperative planning of a PTX, especially in the re-operative setting. A multidisciplinary effort is necessary to address an intrathoracic adenoma. CONCLUSION: Ectopic parathyroid glands should be suspected when positive sestaMIBI uptake is seen in the mediastinum and other types of imaging (e.g. contrast enhanced CT scan or PET-CT) may confirm the finding of an ectopic parathyroid adenoma. From the present case and previous studies we found 11C-MET-PET/CT valuable in difficult PHPT cases.
Journal of Nuclear Cardiology, 2006
Whenever one is evaluating myocardial perfusion scintigraphy (MPS) studies, review of raw projection data is an essential part of the interpreting process. It can identify both quality-control problems and incidental findings. There are multiple causes of technetium 99m sestamibi extracardiac uptake on MPS, including breast cancer, lymphoma, and thyroid abnormalities. We present the case of a patient who was evaluated with Tc-99m sestamibi MPS after an episode of atypical chest pain. The projection images demonstrated an area of abnormal Tc-99m sestamibi uptake in the chest, which was interpreted as a possible ectopic parathyroid adenoma.
Mediastinal Parathyroid Adenoma and Brown Tumors
World Journal of Nuclear Medicine, 2012
In this report, we describe a rare case of brown tumor and mediastinal parathyroid adenoma. This report emphasizes the value of radionuclide scintigraphy in the setting of persistent disease following parathyroid surgery.