The soft tissue lesions are likely representing asymmetrically enlarged parathyroid glands. Regarding the history, clinical status and laboratory results, the possibility of secondary parathyroid hyperplasia is the prime consideration. Chronic kidney disease is the usual etiology of secondary parathyroid hyperplasia.

Nuclear medicine (Tc-99m MIBI) is the current modality of choice for confirming the diagnosis and identifying ectopic sites of parathyroid tissues. The differential diagnosis is multiple parathyroid adenoma.

Parathyroid cysts are rare and can be functional. They can occur in parathyroid adenoma or hyperplasia or as a rare incidental finding. Fine needle aspiration and fluid analysis for parathyroid hormone content should be done for neck cysts of unknown origin ¹.