A case of ectopic para-tracheal parathyroid adenoma identified with whole-body 99mTc-sestamibi scan

• DOI: 10.1016/j.jecr.2022.100119
• Publication Date: 2022-05-24T06:06:19Z
• Authors: Anisley Valenciaga; Jennifer Wittwer; Benjamin O'Donnell; Abberly Lott Limbach; Chadwick L Wright; Steven W Ing
• Keywords: Parathyroid gland

Ectopic parathyroid glands are not rare. They usually located between the mandible and mediastinum, localized with standard imaging modalities (99mTc-sestamibi subtraction scintigraphy 4D-CT). We report case of a 67-year-old woman severe hypercalcemia due to symptomatic primary hyperparathyroidism whose preoperative 99mTc-sestamibi 4D-CT scans were non-localizing. During 4-gland exploration, one hypercellular was excised, two normocellular parathyroids biopsied, bilateral low internal jugular vein sampling showed similar hormone (PTH) levels. Despite treatment zolendronic acid cinacalcet, PHPT persisted. A99mTc-sestamibi study using modified anterior posterior whole-body protocol SPECT/CT revealed mild focal uptake in right para-tracheal area, correlating mass on SPECT/CT. Sestamibi visually more conspicuous projection image. Thoracoscopic resection this gland (2.6 × 1.5 0.7 cm) composed almost entirely chief cells. The lack identifiable oxyphil content could explain or limited radiotracer uptake. differed from timing administration, image capture, types images obtained account for eventual visualization ectopic tissue, may be considered challenging cases suspected gland.