Ectopic Parathyroid Adenoma Localized by Tc-99m Sestamibi SPECT/CT Localization Prior to Re-operation is Useful

Case Report

J Mol Biol & Mol Imaging. 2016; 3(1): 1026.

Ectopic Parathyroid Adenoma Localized by Tc-99m Sestamibi SPECT/CT Localization Prior to Re-operation is Useful

Purbhoo KP¹*, Bombil I² and Mpanya D¹

¹Department of Nuclear Medicine and Molecular Imaging, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

²Department of Surgery, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

*Corresponding author: Purbhoo KP, Department of Nuclear medicine and molecular imaging, University of the Witwatersrand, P.O Bertsham, Johannesburg 2013, South Africa

Received: August 02, 2016; Accepted: June 29, 2016; Published: August 24, 2016

Abstract

We present a 31-year old male patient with primary hyperparathyroidism (PHPT), complicated by obstructive uropathy due to a staghorn calculus. He had minimally invasive right lower pole parathyroidectomy (MIP), following localization in the right lower pole of the parathyroid gland, on ultrasound. Postsurgical histology confirmed it to be a lymph node. The serum calcium and PTH levels remained elevated post-operative. Tc-99m methoxyisobutyl isonitrile (Sestamibi) planar imaging showed a focus of uptake superior to the upper pole of the right thyroid gland, that was localized lateral to the right true vocal cord on SPECT/CT. Post- operative histology confirmed a parathyroid adenoma.

Keywords: Ectopic parathyroid adenoma; Tc-99m; Sestamibi; Primary hyperparathyroidism; SPECT/CT

Case Presentation

A 31-year old male patient with a diagnosis of PHPT was sent to Nuclear Medicine with persistently raised serum calcium and parathyroid hormone (PTH) levels, following MIP. His hyperparathyroidism was complicated by obstructive uropathy, due to a staghorn calculus, for which he had a double J stent insitu. The ultrasound done prior to surgery showed an enlarged lesion in the right lower pole of the parathyroid gland. Post-surgical histology confirmed it to be a lymph node. No parathyroid gland was demonstrated. The serum calcium and PTH levels remained elevated post-operative. 20 mCi (740MBq) Tc-99m Sestamibi planar imaging (Figure 1) showed a solitary focus of uptake superior to the upper pole of the right thyroid gland, suspicious for a parathyroid lesion. Differential washout of tracer is seen from the immediate to the 3 hour image [black arrows] with a clearer delineation of the lesion on delayed imaging. Single Photon Emission Computed Tomography with CT [SPECT/CT], (Figure 2) demonstrated increased uptake lateral to the right true vocal cord. The patient had removal of the lesion by MIP confirming a parathyroid adenoma (Figure 3). The patients’ serum calcium and PTH levels reverted to the normal range post-surgery.