Paraesophageal ectopic parathyroid adenoma

Case contributed by Dr Abdullah Alqudah

Presentation

History of hypercalcaemia with parathyroid adenoma. Left partial thyroidectomy three weeks previously. Ongoing refractory hypercalcaemia.

Patient Data

Age: 70 year old
Gender: Female
Modality: CT

Well-defined enhancing soft tissue nodule is seen in the left paraesophageal region measuring 12 mm; in light of the patient's history this is concerning for ectopic parathyroid adenoma.

8 x 6 mm hypodense nodule is seen in relation to the anterior margin of the left thyroid lobe. Small subcutaneous collection noted anterior to the thyroid gland measuring about 2 x 1 cm associated with thickening of the strap muscles and stranding of the surrounding fatty planes; representing postoperative changes.

Modality: Nuclear medicine

Early homogeneous uptake in both thyroid lobes.
Good washout from thyroid gland with focal delayed washout close to the left lower pole continuous along the left paraesophageal region down to the superior mediastinum, consistent with left inferior/ectopic parathyroid adenoma

Case Discussion

Despite the parathyroid adenoma resection, there was ongoing hypercalcaemia. These post-operative CT and Sestamibi scans suggest a further paraesophageal ectopic adenoma, pedunculated from the left lower thyroid lobe.

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Case Information

rID: 49706
Case created: 30th Nov 2016
Last edited: 6th Dec 2016
System: Head & Neck
Inclusion in quiz mode: Included

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