Parathyroid adenoma - ectopic paraesophageal

Case contributed by Abdallah Alqudah
Diagnosis almost certain


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

Patient Data

Age: 70 years
Gender: Female

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.

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 hypercalcemia. These post-operative CT and Sestamibi scans suggest a further paraesophageal ectopic adenoma, pedunculated from the left lower thyroid lobe.

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