An ectopic mediastinal parathyroid adenoma accurately located by a single-day imaging protocol of Tc-99m pertechnetate-MIBI subtraction scintigraphy and MIBI-SPECT-computed tomographic image fusion.

Abstract

PURPOSE:

Because ectopic parathyroid adenoma (PA) is a frequent cause of failed initial surgery, an imaging approach with accurate preoperative localization is recommended by some authors in patients with primary hyperparathyroidism (HPT).

METHODS:

The authors describe a 52-year-old woman in whom primary HPT was diagnosed incidentally during a screening program for osteoporosis. The peculiarity of this case is that the patient was examined before operation in a single-day multimodal imaging protocol based on the combination of high-resolution cervical ultrasound, planar Tc-99m pertechnetate-MIBI scans, and an MIBI-SPECT-computed tomographic (CT) image fusion study. An ectopic PA was accurately located in the upper middle mediastinum, close to the lower margin of the sternal notch.

RESULTS:

Guided by the MIBI-SPECT-CT fusion images, the surgeon performed a limited median sternotomy and easily removed the PA that was revealed before operation. To confirm the completeness of resection, a bilateral neck exploration was performed through the same incision, with identification of three normally sized parathyroid glands.

CONCLUSIONS:

Our experience suggests the utility of multimodality imaging procedures for the accurate preoperative localization of PAs, particularly when they are present in ectopic mediastinal locations. Such procedures, including the MIBI-SPECT-CT image fusion study, can be performed in a single day.

• Authors: Domenico Rubello, Dario Casara, Davide Fiore, Piercarlo Muzzio, Giancarlo Zonzin, Brahm Shapiro
• Journal: Clinical nuclear medicine (Clin Nucl Med) Vol. 27 Issue 3 Pg. 186-90 (Mar 2002) ISSN: 0363-9762 [Print] United States
• PMID: 11852306 (Publication Type: Case Reports, Journal Article)

Chemical References

• Radiopharmaceuticals
• Technetium Compounds
• Technetium Tc 99m Sestamibi
• Sodium Pertechnetate Tc 99m

Topics

• Adenoma
• Choristoma (diagnostic imaging, surgery)
• Female
• Humans
• Hyperparathyroidism (diagnostic imaging)
• Mediastinal Diseases (diagnostic imaging, surgery)
• Middle Aged
• Parathyroid Neoplasms
• Radiopharmaceuticals
• Sodium Pertechnetate Tc 99m
• Subtraction Technique
• Technetium Compounds
• Technetium Tc 99m Sestamibi
• Tomography, Emission-Computed, Single-Photon (methods)
• Tomography, X-Ray Computed