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Giant cystic parathyroid adenoma with thrombosis of internal jugular vein seen on CT and Tc-99m methoxy isobutyl isonitrile parathyroid scan
Address for correspondence: Dr. Maseeh uz Zaman, Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan. E-mail: maseeh.uzzaman@aku.edu
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Abstract
Primary hyper-parathyroidism is attributed by a solitary parathyroid adenoma in 80-85% cases and mostly are non-palpable and needs imaging for localization. Cystic degeneration of parathyroid adenoma is rarely seen in primary hyperparathyroidism. We are presenting a case of giant cystic functioning parathyroid adenoma with associated localized co-morbids.
Keywords
Cystic parathyroid adenoma
internal jugular vein thrombosis
primary hyperparathyroidism
Tc-99m methoxy isobutyl isonitrile
INTRODUCTION
Parathyroid scintigraphy using Tc-99m methoxy isobutyl isonitrile (MIBI) has become a popular imaging modality for localization of functioning parathyroid adenoma. It is considered more important in cases of multi-glandular disease. Localization of adenoma by scintigraphic technique, signs and symptoms has good correlation with size of the adenoma.
CASE REPORT
A 54-year-old female presented with 3 years history of bony pains, muscle weakness, fatigue, and depression with soft tissue swelling over left thyroid bed and left upper limb. Serum calcium and parathormone levels were abnormally high (17.4 mg/dl and 1182 pg/ml, respectively). Tc-99m MIBI scan revealed a large area of non-homogenous tracer uptake over left thyroid bed and superior mediastinum displacing the thyroid toward right [Figure 1]. In view of raised serum calcium and parathormone levels, it was considered a cystic parathyroid adenoma as non-functional (true) parathyroid cysts are also a known entity.[1] An associated cold defect has been reported in patients with cytsic parathyroid adenoma.[2] Cytic adenomas have been reported to occur in hypercalcemic crisis as the result of acute necrosis or hemorrhage of a parathyroidadenoma.[3]
Computed tomography scan showed a large left-sided parathyroid adenoma with marked cystic changes and thrombosis of left internal jugular vein [Figure 2]. Cystic degeneration of parathyroid adenoma is reported in 1-2% cases with primary hyperparathyroidism,[45] and 4% of abnormal parathyroid glands.[6] Thrombosis of left internal jugular vein has been reported in few case reports.[7] Excisional biopsy revealed cystic parathyroid adenoma with no evidence of malignancy.
Source of Support: Nil
Conflict of Interest: None declared
REFERENCES
- Cystic parathyroid adenoma: Sonographic features and correlation with 99mTc-sestamibi SPECT findings. AJR Am J Roentgenol. 2010;195:1385-90.
- [Google Scholar]
- Parathyroid cysts: A report of eleven cases including two associated with hyperparathyroid crisis. Surgery. 1983;94:887-92.
- [Google Scholar]
- Cystic parathyroid lesions: Functional and nonfunctional parathyroid cysts. Arch Surg. 2009;144:52-6.
- [Google Scholar]
- Giant functioning parathyroid cyst presenting as a retrosternal goitre. ANZ J Surg. 2007;77:297-304.
- [Google Scholar]