Large Carotid Sheath Parathyroid Adenoma Localized by Tc-99m Sestamibi

Abstract

The use of Tc-99m sestamibi to localize parathyroid adenomas is well established. Its greatest value is in the detection of adenomas in presurgical candidates to localize one or more adenomas in the parathyroid glands or to identify ectopic parathyroid adenomas. The authors describe a patient who had long-standing hyperparathyroidism with a history of end-stage renal disease, hypertension, and peptic ulcers with gastrointestinal bleeding. The scan showed a large ectopic parathyroid adenoma in the left retrosternocleidomastoid region. At surgery, the adenoma was located between the jugular vein and the carotid artery, within the carotid sheath.

Indocyanine green fluorescence guided resection of parathyroid adenoma of the carotid sheath: a case report and review of the literature

“…Though carotid sheath involvement is rare (11,12), identification and resection of parathyroid adenomas within the sheath has been demonstrated to be especially difficult. Groups have previously described cases in which failed primary surgery for hyperparathyroidism has been attributed to adenomas later localized to the carotid sheath (13)(14)(15)17). Ojha et al described identification of a carotid sheath parathyroid adenoma between the carotid artery and jugular vein via Tc-99m Sestamibi after failed primary resection (17).…”

“…Groups have previously described cases in which failed primary surgery for hyperparathyroidism has been attributed to adenomas later localized to the carotid sheath (13)(14)(15)17). Ojha et al described identification of a carotid sheath parathyroid adenoma between the carotid artery and jugular vein via Tc-99m Sestamibi after failed primary resection (17). After SPECT/CT and ultrasound failed to reveal obvious pathology and a subsequent negative neck exploration, Chopra et al identified a 4 cm parathyroid adenoma on contrast-enhanced CT posterior to the common carotid artery which was later resected successfully (15).…”