Ipponsugi S, Takamori S, Suga K, Koga T, Hayashi A, Sirouzu K, Ishibashi M, Watanabe J, Jimi A
First Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
Surg Today. 1997;27(1):80-3. doi: 10.1007/BF01366946.
We report herein the case of a 30-year-old man in whom ectopic mediastinal parathyroid adenoma was detected by 99mTc-methoxyisobutylisonitrile scintigraphy (99mTc-MIBI). The patient presented with a history of recurrent renal stones and was diagnosed as having primary hyperparathyroidism due to elevated serum levels of calcium and intact parathyroid hormone (i-PTH) levels. On admission, his serum calcium value was 12.1 mg/dl and the i-PTH level was 137 pg/ml. Ultrasonography, computed tomography (CT), and 201TlCl-99mTcO4- subtraction scintigraphy (Tl-Tc) were performed but none of these imaging techniques was able to detect an enlarged parathyroid gland. Selective venous sampling revealed that the serum i-PTH level was highest at 422 pg/ml in the left brachiocephalic vein. Exploration of the neck also proved unsuccessful. Finally, we performed 99mTc-MIBI which revealed and delineated an enlarged parathyroid gland in the upper mediastinum. Tumor extirpation was subsequently performed through a left thoracotomy. Pathologically, the tumor was confirmed to be a parathyroid adenoma and the serum calcium and i-PTH levels returned to within the normal ranges postoperatively.
我们在此报告一例30岁男性患者，通过99mTc-甲氧基异丁基异腈闪烁扫描法（99mTc-MIBI）检测到异位纵隔甲状旁腺腺瘤。该患者有复发性肾结石病史，因血清钙水平和完整甲状旁腺激素（i-PTH）水平升高被诊断为原发性甲状旁腺功能亢进。入院时，他的血清钙值为12.1mg/dl，i-PTH水平为137pg/ml。进行了超声检查、计算机断层扫描（CT）和201TlCl-99mTcO4-减影闪烁扫描（Tl-Tc），但这些成像技术均未能检测到增大的甲状旁腺。选择性静脉采血显示，左头臂静脉的血清i-PTH水平最高，为422pg/ml。颈部探查也未成功。最后，我们进行了99mTc-MIBI检查，发现并勾勒出上纵隔内一个增大的甲状旁腺。随后通过左胸切开术进行了肿瘤切除。病理检查证实肿瘤为甲状旁腺腺瘤，术后血清钙和i-PTH水平恢复到正常范围。
