A 74-year old female showed abnormal hypercalcemia on pre-operative lab (she was scheduled to have TKRA)
Neck sonography was asked to rule out primary hypercalcemia
![Parathyroid adenoma](https://q-radiology.com/wp-content/uploads/2022/11/image-77-1024x777.png)
![Parathyroid adenoma](https://q-radiology.com/wp-content/uploads/2022/11/image-78-1024x805.png)
Color doppler image shows ‘polar feeding artery’
![Parathyroid adenoma](https://q-radiology.com/wp-content/uploads/2022/11/image-79.png)
delayed image shows hot uptake at right parathyroid gland
the location of the lesion well correlates with ultrasonography
- Parathyroid gland
- 35-40mg
- Yellow
- Supplied from end artery (esp. ITA branch)
- Inferior parathyroid gland – 3rd branchial pouch ; long migration path makes more ectopic location of it
- Superior parathyroid gland – 4th branchial pouch
- Parathyroid adenoma is a benign tumor of the parathyroid gland and the most common cause of primary hyperparathyroidism
– The cause of primary hyperparathyroidism ; Parathyroid adenoma (80-85%), primary parathyroid hyperplasia (15%), parathyroid carcinoma(5%)
- Clinical presentation
- Non-specific symptoms (fatigue, weakness)
- Elevated serum calcium levels and elevated serum parathyroid hormone levels
- Elevated serum calcium levels and elevated serum parathyroid hormone levels
- Non-specific symptoms (fatigue, weakness)
- US features
- Hypoechoic solid mass with oval, bean-like or multilobulated shape
- **cystic degeneration in 2%
- Color or power Doppler US
– Polar feeding artery to one pole generally from inf. thyroidal artery
– Location Posterior or inferior to thyroid gland
- Nuclear medicine
- 99mTc-sestamibi SPECT (photon energy: 140 KeV)
– Diffuse passively across cell membrane, concentrate in mitochondria - Parathyroid adenomas are best demonstrated on delayed imaging (1-2 hours)
- 99mTc-sestamibi SPECT (photon energy: 140 KeV)