Presentation
High parathyroid hormone and calcium levels.
Patient Data
Normal size thyroid gland with heterogeneous parenchymal echotexture.
Heterogeneous hypoechoic oval nodule measuring 1.6 x 3.3 cm containing small cystic areas and lying adjacent to the posterior aspect of the left thyroid lobe. No calcifications. Mild internal vascularity on colour Doppler.
Ovoid nodule measuring 1.5 x 3.0 x 4.2 cm adjacent to the posterosuperior aspect of the left thyroid lobe, of soft-tissue attenuation on non-contrast CT. It shows heterogeneous enhancement during the arterial phase and some washout during the venous phase. Multiple small non-enhancing cystic/necrotic areas are seen within it. No calcifications. Hypertrophied artery entering the lower pole, a branch of the left inferior thyroid artery. Normal right parathyroid gland region.
Normal size thyroid gland showing normal hyper-attenuation on non-contrast CT and mildly heterogeneous parenchymal enhancement.
Multiple normal small bilateral lymph nodes.
Histopathology of the left parathyroidectomy specimen showed parathyroid gland adenoma with cystic degeneration.
Case Discussion
Ultrasound (US) and CT scan showed an enlarged left superior parathyroid gland adenoma. Multiple cystic foci noted within the lesion on both US and CT scan. The lesion was resected and the histopathology confirmed parathyroid adenoma with cystic degeneration.
Attenuation on non-contrast CT is lower than that of normal thyroid tissue as the parathyroid gland do not concentrate iodine.
This adenoma is easy to detect because of its size and location. Parathyroid adenomas are often very small and can be ectopic.
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