J Korean Soc Radiol.  2019 Jan;80(1):147-152. 10.3348/jksr.2019.80.1.147.

Ectopic Mediastinal Parathyroid Adenoma in a Patient with Chronic Kidney Disease: A Case Report

• Choo DM
• Kim JH
• Kim SS

• KMID: 2442475
• DOI: http://doi.org/10.3348/jksr.2019.80.1.147

Abstract

We report an ectopic mediastinal parathyroid adenoma in a patient with chronic kidney disease who presented with refractory hypercalcemia. Technetium-99m-sestamibi scintigraphy is a valuable imaging technique for the detection of an ectopic parathyroid adenoma in the mediastinum. The combination of intense contrast enhancement and the identification of a polar vessel on a computed tomography scan will ensure that a radiologist can differentiate a parathyroid adenoma from other pathologies in the mediastinum. By virtue of the advancement of imaging modalities, localization of an ectopic mediastinal parathyroid adenoma prior to surgery is possible and unnecessary neck exploration is avoidable.

MeSH Terms

Humans
Hypercalcemia
Hyperparathyroidism
Mediastinal Neoplasms
Mediastinum
Neck
Parathyroid Neoplasms*
Pathology
Radionuclide Imaging
Renal Insufficiency, Chronic*
Technetium Tc 99m Sestamibi
Virtues
Technetium Tc 99m Sestamibi

Figure

• 

  Fig. 1. An ectopic anterior mediastinal parathyroid adenoma in a 63-year-old woman. A. Initial posteroanterior chest radiograph shows widening with contour bulging of the right mediastinum (arrow). B. A contrast-enhanced chest computed tomography axial image shows a highly enhancing soft tissue mass in the right anterior mediastinum, measuring 4 × 3 cm. The mass is located anterior to the superior vena cava (arrow). C. Three-dimensional volume rendering reconstruction image demonstrates an enlarged tortuous feed-ing artery originating from the right internal mammary artery (arrowheads) and a dilated vein draining to the right internal mammary vein at the inferior pole of the tumor (arrows).

• 

  Fig. 1. An ectopic anterior mediastinal parathyroid adenoma in a 63-year-old woman. D. Early phase (left) and delayed phase (middle) coronaldual-phase Technetium-99m-sestamibi scintigraphy and fused single photon emission computed tomography/computed tomography (right) images depict a focal and persistent abnormal tracer accumulation in the right anterior mediastinal mass. E. Gross specimen photograph shows a resected ectopic parathyroid adenoma (4 cm). The tumor is well encapsulated and firmly adhered to fatty thy-mic tissue.

Reference

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