Presentation
Hyperparathyroidism. Prior right hemithyroidectomy.
Patient Data
There is focal intense tracer accumulation associated with an elongated soft tissue structure at the level of the thoracic inlet (anterior to the right brachiocephalic artery and left common carotid artery and posteromedial to the left clavicular head). The CT structure measures approximately 15 x 5 mm.
No additional focal intense uptake of choline is seen within the lower neck or upper thorax to indicate additional parathyroid adenoma. Right hemithyroidectomy noted.
Tracer distribution elsewhere is considered within physiological limits.
Conclusion
Case Discussion
The exact mechanism of uptake of 18F labeled choline is not fully understood, however it demonstrates accumulation in hyperfunctioning parathyroid glands. It has demonstrated higher sensitivity than 99mTc-sestamibi scans 1.
This patient presented with an elevated serum parathyroid hormone level despite a negative parathyroid sestamibi scan, 4DCT parathyroid and ultrasound neck. Following this study, they underwent minimally invasive parathyroidectomy. The histology report confirms parathyroid adenoma.
Histopathology Report (Left inferior parathyroid + thymus):
Macroscopic Description: The specimen consists of a brown/tan nodule (consistent with possible parathyroid) with a smooth and shiny surface measuring 12x10x3mm. The isolated possible parathyroid weighs 0.4 g.
Microscopic Description: A nodule of fat-depleted parathyroid tissue, comprises chief cells in microacini, with a few scattered sheets of oxyphil cells, with no cytological atypia or mitotic activity. There is no thick encapsulation and no thick fibrous bands within the nodule.
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