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Parathyroid Adenoma in Visceral Space
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Parathyroid adenoma (PT Ad)
            • Definitions

              • Benign neoplasm of parathyroid gland producing excess parathyroid hormone (PTH), resulting in hypercalcemia

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Angiographic Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Bahl M et al: Parathyroid adenomas and hyperplasia on four-dimensional CT scans: three patterns of enhancement relative to the thyroid gland justify a three-phase protocol. Radiology. 277(2):454-62, 2015
                                              2. Michaud L et al: A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies. Medicine (Baltimore). 94(41):e1701, 2015
                                              3. Bahl M et al: Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT. AJNR Am J Neuroradiol. 35(3):578-81, 2014
                                              4. Raghavan P et al: Dynamic CT for parathyroid disease: are multiple phases necessary? AJNR Am J Neuroradiol. 35(10):1959-64, 2014
                                              5. Aliyev A et al: Ectopic parathyroid adenoma localized with MIBI scintigraphy and excised with guide of macroaggregated human serum albumin injection. Clin Nucl Med. 35(3):151-3, 2010
                                              6. Patel CN et al: Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol. 65(4):278-87, 2010
                                              7. Harari A et al: Negative preoperative localization leads to greater resource use in the era of minimally invasive parathyroidectomy. Am J Surg. 197(6):769-73, 2009
                                              8. Levine DS et al: Hybrid SPECT/CT imaging for primary hyperparathyroidism: case reports and pictorial review. Clin Nucl Med. 34(11):779-84, 2009
                                              9. Prommegger R et al: Virtual neck exploration: a new method for localizing abnormal parathyroid glands. Ann Surg. 250(5):761-5, 2009
                                              10. Randall GJ et al: Contrast-enhanced MDCT characteristics of parathyroid adenomas. AJR Am J Roentgenol. 193(2):W139-43, 2009
                                              11. Thomas DL et al: Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 34(10):651-5, 2009
                                              12. Usmani S et al: Minimally invasive radionuclide-guided parathyroidectomy using 99mTc-sestamibi in patients with primary hyperparathyroidism: a single-institution experience. Med Princ Pract. 18(5):373-7, 2009
                                              13. Harari A et al: Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning. Surgery. 144(6):970-6; discussion 976-9, 2008
                                              14. Parker EE et al: MR imaging of the thoracic inlet. Magn Reson Imaging Clin N Am. 16(2):341-53, x, 2008
                                              15. Rodgers SE et al: Primary hyperparathyroidism. Curr Opin Oncol. 20(1):52-8, 2008
                                              16. Zald PB et al: The role of computed tomography for localization of parathyroid adenomas. Laryngoscope. 118(8):1405-10, 2008
                                              17. Mazzeo S et al: Multidetector CT in diagnostic work-up of patients with primary hyperparathyroidism. Radiol Med. 112(5):763-75, 2007
                                              18. Rodgers SE et al: Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 140(6):932-40; discussion 940-1, 2006
                                              19. Bentrem DJ et al: Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperparathyroidism? Thyroid. 12(12):1109-12, 2002
                                              20. van Dalen A et al: Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology. 220(3):631-9, 2001
                                              21. Weber AL et al: The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am. 38(5):1105-29, 2000
                                              22. Purcell GP et al: Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi. Arch Surg. 134(8):824-8; discussion 828-30, 1999
                                              23. Ishibashi M et al: Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med. 39(2):320-4, 1998
                                              24. Norman J et al: Minimally invasive radioguided parathyroidectomy in the reoperative neck. Surgery. 124(6):1088-92; discussion 1092-3, 1998
                                              25. Ishibashi M et al: Localization of ectopic parathyroid glands using technetium-99m sestamibi imaging: comparison with magnetic resonance and computed tomographic imaging. Eur J Nucl Med. 24(2):197-201, 1997
                                              26. Neumann DR et al: Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism. AJR Am J Roentgenol. 169(6):1671-4, 1997
                                              27. Gordon BM et al: Parathyroid imaging with 99m Tc-sestamibi. AJR Am J Roentgenol. 167(6):1563-8, 1996
                                              28. Lee VS et al: The complementary roles of fast spin-echo MR imaging and double-phase 99m Tc-sestamibi scintigraphy for localization of hyperfunctioning parathyroid glands. AJR Am J Roentgenol. 167(6):1555-62, 1996
                                              29. Vojvodich SM et al: Imaging and surgery in hyperparathyroidism: a 10-year review. J Otolaryngol. 25(2):126-9, 1996
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Parathyroid adenoma (PT Ad)
                                                        • Definitions

                                                          • Benign neoplasm of parathyroid gland producing excess parathyroid hormone (PTH), resulting in hypercalcemia

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Angiographic Findings

                                                                  • Nuclear Medicine Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Bahl M et al: Parathyroid adenomas and hyperplasia on four-dimensional CT scans: three patterns of enhancement relative to the thyroid gland justify a three-phase protocol. Radiology. 277(2):454-62, 2015
                                                                                          2. Michaud L et al: A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies. Medicine (Baltimore). 94(41):e1701, 2015
                                                                                          3. Bahl M et al: Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT. AJNR Am J Neuroradiol. 35(3):578-81, 2014
                                                                                          4. Raghavan P et al: Dynamic CT for parathyroid disease: are multiple phases necessary? AJNR Am J Neuroradiol. 35(10):1959-64, 2014
                                                                                          5. Aliyev A et al: Ectopic parathyroid adenoma localized with MIBI scintigraphy and excised with guide of macroaggregated human serum albumin injection. Clin Nucl Med. 35(3):151-3, 2010
                                                                                          6. Patel CN et al: Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol. 65(4):278-87, 2010
                                                                                          7. Harari A et al: Negative preoperative localization leads to greater resource use in the era of minimally invasive parathyroidectomy. Am J Surg. 197(6):769-73, 2009
                                                                                          8. Levine DS et al: Hybrid SPECT/CT imaging for primary hyperparathyroidism: case reports and pictorial review. Clin Nucl Med. 34(11):779-84, 2009
                                                                                          9. Prommegger R et al: Virtual neck exploration: a new method for localizing abnormal parathyroid glands. Ann Surg. 250(5):761-5, 2009
                                                                                          10. Randall GJ et al: Contrast-enhanced MDCT characteristics of parathyroid adenomas. AJR Am J Roentgenol. 193(2):W139-43, 2009
                                                                                          11. Thomas DL et al: Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 34(10):651-5, 2009
                                                                                          12. Usmani S et al: Minimally invasive radionuclide-guided parathyroidectomy using 99mTc-sestamibi in patients with primary hyperparathyroidism: a single-institution experience. Med Princ Pract. 18(5):373-7, 2009
                                                                                          13. Harari A et al: Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning. Surgery. 144(6):970-6; discussion 976-9, 2008
                                                                                          14. Parker EE et al: MR imaging of the thoracic inlet. Magn Reson Imaging Clin N Am. 16(2):341-53, x, 2008
                                                                                          15. Rodgers SE et al: Primary hyperparathyroidism. Curr Opin Oncol. 20(1):52-8, 2008
                                                                                          16. Zald PB et al: The role of computed tomography for localization of parathyroid adenomas. Laryngoscope. 118(8):1405-10, 2008
                                                                                          17. Mazzeo S et al: Multidetector CT in diagnostic work-up of patients with primary hyperparathyroidism. Radiol Med. 112(5):763-75, 2007
                                                                                          18. Rodgers SE et al: Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 140(6):932-40; discussion 940-1, 2006
                                                                                          19. Bentrem DJ et al: Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperparathyroidism? Thyroid. 12(12):1109-12, 2002
                                                                                          20. van Dalen A et al: Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology. 220(3):631-9, 2001
                                                                                          21. Weber AL et al: The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am. 38(5):1105-29, 2000
                                                                                          22. Purcell GP et al: Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi. Arch Surg. 134(8):824-8; discussion 828-30, 1999
                                                                                          23. Ishibashi M et al: Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med. 39(2):320-4, 1998
                                                                                          24. Norman J et al: Minimally invasive radioguided parathyroidectomy in the reoperative neck. Surgery. 124(6):1088-92; discussion 1092-3, 1998
                                                                                          25. Ishibashi M et al: Localization of ectopic parathyroid glands using technetium-99m sestamibi imaging: comparison with magnetic resonance and computed tomographic imaging. Eur J Nucl Med. 24(2):197-201, 1997
                                                                                          26. Neumann DR et al: Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism. AJR Am J Roentgenol. 169(6):1671-4, 1997
                                                                                          27. Gordon BM et al: Parathyroid imaging with 99m Tc-sestamibi. AJR Am J Roentgenol. 167(6):1563-8, 1996
                                                                                          28. Lee VS et al: The complementary roles of fast spin-echo MR imaging and double-phase 99m Tc-sestamibi scintigraphy for localization of hyperfunctioning parathyroid glands. AJR Am J Roentgenol. 167(6):1555-62, 1996
                                                                                          29. Vojvodich SM et al: Imaging and surgery in hyperparathyroidism: a 10-year review. J Otolaryngol. 25(2):126-9, 1996