Bayya Nikhil, Rowell Colin, Malek Daniel, Andrews R Hampton, Dobzyniak Christopher
Department of Radiology, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501, USA.
Medical Center Radiologists, Virginia Beach, VA.
Radiol Case Rep. 2020 Sep 23;15(11):2418-2421. doi: 10.1016/j.radcr.2020.09.030. eCollection 2020 Nov.
Primary hyperparathyroidism is most commonly caused by adenoma formation in one of the 4 parathyroid glands. The presence of ectopic parathyroid tissue is relatively common and can lead to difficulties in identification and treatment if affected by adenoma. This report describes the case of a 45-year-old female who presented 10 years status post thyroidectomy with symptomatic hyperparathyroidism and found to have ectopic parathyroid adenoma in the anterior mediastinum. Parathyroid scintigraphy with 99m-Technetium sestamibi and computed tomography were used for localization of the adenoma to a 1.9-centimeter para-aortic nodule. Computed tomography-guided transsternal cryoablation was subsequently performed for treatment, with intraoperative evaluation of serum parathyroid and calcium levels for confirmation. This case highlights that a sharp increase in parathyroid hormone immediately after cryoablation is not necessary for successful confirmation of the procedure. It additionally contributes to the growing literature on computed tomography-guided cryoablation as a legitimate alternative to surgery for treatment of ectopic parathyroid adenoma.
原发性甲状旁腺功能亢进最常见的病因是4个甲状旁腺之一形成腺瘤。异位甲状旁腺组织较为常见，如果受腺瘤影响，可能会导致识别和治疗困难。本报告描述了一例45岁女性病例，该患者在甲状腺切除术后10年出现症状性甲状旁腺功能亢进，经检查发现前纵隔有异位甲状旁腺腺瘤。使用99m-锝甲氧基异丁基异腈进行甲状旁腺闪烁扫描和计算机断层扫描，将腺瘤定位到一个1.9厘米的主动脉旁结节。随后进行了计算机断层扫描引导下的经胸骨冷冻消融治疗，并在术中评估血清甲状旁腺素和钙水平以进行确认。该病例表明，冷冻消融术后甲状旁腺激素立即急剧升高并非手术成功确认的必要条件。它还为有关计算机断层扫描引导下冷冻消融作为治疗异位甲状旁腺腺瘤的一种合理替代手术方法的文献增添了内容。
