Parathyroid adenoma

Case contributed by Patrick Matulich
Diagnosis almost certain

Presentation

Four-year history of asymptomatic hypercalcaemia and hypercalciuria associated with hyperparathyroidism being managed medically. Seen by endocrinology for follow up of her hyperparathyroidism.

Patient Data

Age: 55 years
Gender: Female

Left thyroid

ultrasound
Longitudinal
Transverse
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Hypoechoic mass measuring 2.5 x 1.5 x 1.1 cm immediately deep to the left thyroid lobe. Colour doppler images demonstrate internal vascularity.

99mTc-sestamibi scintigraphy

Nuclear medicine
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Avid radiotracer uptake over the region of the left thyroid on immediate images which persists on 2 hour delayed images.

ct
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Isodense nodule measuring 1.3 x 0.9 cm posterior to the left thyroid.

SPECT-CT

Nuclear medicine
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Physiologic mild bilateral thyroid radiotracer uptake with intense focal radiotracer uptake in the soft tissue nodule posterior to the left thyroid lobe.

Case Discussion

A classic example of a parathyroid adenoma in a patient with a history of asymptomatic hyperparathyroidism. Initially visualised with ultrasound, and subsequently seen on scintigraphy and SPECT/CT.

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