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INTERESTING IMAGES
Year : 2017  |  Volume : 32  |  Issue : 3  |  Page : 235-236  

Ectopic parathyroid incidentaloma on Tc99M sestamibi myocardial perfusion imaging


Department of Radiology, Salmaniaya Medical Complex, Manama, Kingdom of Bahrain

Date of Web Publication13-Jun-2017

Correspondence Address:
S K Chirala
Nuclear Medicine Consultant, Department of Radiology, Salmaniaya Medical Complex, PB 12, Manama 311
Kingdom of Bahrain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_5_17

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   Abstract 

Parathyroid incidentalomas are generally discovered during thyroid surgery. [1]In the present case, the ectopic parathyroid adenoma was discovered as an incidentaloma in a clinical setting, during the course of clinical evaluation of atypical chest pain by gastroenterology and cardiology.

Keywords: Ectopic parathyroid adenoma, myocardial perfusion imaging, parathyroid incidentaloma


How to cite this article:
Hussain RA, Ali AM, Manivannan K, Chirala S K. Ectopic parathyroid incidentaloma on Tc99M sestamibi myocardial perfusion imaging. Indian J Nucl Med 2017;32:235-6

How to cite this URL:
Hussain RA, Ali AM, Manivannan K, Chirala S K. Ectopic parathyroid incidentaloma on Tc99M sestamibi myocardial perfusion imaging. Indian J Nucl Med [serial online] 2017 [cited 2017 Sep 26];32:235-6. Available from: http://www.ijnm.in/text.asp?2017/32/3/235/207895

During 99mTc sestaMIBI-gated Single photon emission tomography (SPECT) Myocardial perfusion imaging (MPI) for the evaluation of atypical chest pain, an anterior mediastinal lesion was discovered [Figure 1]. Dual-phase 99mTc sestaMIBI parathyroid imaging [Figure 2] was carried out, which has shown the retention of radiopharmaceutical in the anterior mediastinal lesion, suggesting ectopic parathyroid adenoma. On further investigation, Computed tomography (CT) scan of the chest [Figure 3] has confirmed 3.2 × 2.3 × 2 cm ectopic parathyroid adenoma in the anterior–superior mediastinum.
Figure 1: 99mTc sestaMIBI MPI GSPECT projection images

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Figure 2: 99mTc sestaMIBI dual-phase scintigraphy

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Figure 3: CT scan chest ectopic parathyroid adenoma

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The term “parathyroid incidentaloma” is used to indicate unexpected parathyroid adenomas that are encountered during surgery.[2],[3] The incidental discovery of parathyroid tumors was first reported by Attie et al. in 1967[1] while he was exploring the neck. It is a rare entity and till now approximately 50 cases have been reported worldwide.[5] With the advent of high-resolution ultrasound examination for thyroid lesion, parathyroid incidentaloma may be revealed prior to surgery.[4]

In the present case, patient was being investigated for atypical chest pain by gastroenterology and later by cardiology departments. Upper Gastrointestinal (GI) endoscopy was normal. During the course of cardiac evaluation, MPI with 99 mTc sestaMIBI, which was negative for inducible ischemia, has suggested the unsuspected ectopic parathyroid adenoma and further directed clinical management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Attie JN, Estrin J, Khafif RA, Dweck F. Parathyroid adenomas discovered incidentally during explorations of the thyroid. Am J Surg 1967;114:538-42.  Back to cited text no. 1
    
2.
Katz AD, Kong LB. Incidental preclinical hyperparathyroidism identified during thyroid operations. Am Surg 1992;58:747-9.  Back to cited text no. 2
    
3.
Carnaille BM, Pattou FN, Oudar C, Lecomte-Houcke MC, Rocha JE, Proye CA. Parathyroid incidentalomas in normocalcemic patients during thyroid surgery. World J Surg 1996;20:830-4.  Back to cited text no. 3
    
4.
Ghervan C, Silaghi A, Nemeş C. Parathyroid incidentaloma detected during thyroid sonography: Prevalence and significance beyond images. Med Ultrason 2012;14:187-91.  Back to cited text no. 4
    
5.
Marchesi M, Biffoni M, Benedetti RN, Campana FP. Incidental parathyroid adenomas with normocalcemia discovered during thyroid operations: Report of three cases. Surg Today 2001;31:996-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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