Localisation of ectopic mediastinal parathyroid adenoma by 18F-fluorocholine PET/CT

Abstract

We report the case of two patients with newly diagnosed primary hyperparathyroidism: a 40-year-old woman during pregnancy and a 60-year-old man with initial hypercalcaemic crisis. In the first case, a bilateral neck exploration with parathyroidectomy during the second trimester of pregnancy was unsuccessful and the patient remained hypercalcaemic. Postpartum imaging assessment with technetium (Tc)-sestamibi scintigraphy could not supply conclusive diagnostic results. The use of F-fluorocholine (FCH) positron emission tomography (PET)/CT provided the accurate localisation of an ectopic parathyroid adenoma in the anterior mediastinum which was successfully resected by a thoracoscopic approach. In the second case,Tc-sestamibi scintigraphy was inconclusive as well and FCH-PET/CT localised an ectopic parathyroid adenoma in the mediastinum and thus bilateral neck exploration could be spared. Both patients had surgical cure of their disease.

Giant Ectopic Parathyroid Adenoma Arising in the Posterior Mediastinum. Report of Case and a Review

“…A comparison is made between 99m Tc-sestamibi scintigraphy combined with single photon emission CT (SPECT)/CT and 18 F-fluorocholine PET/CT (FCH-PET/CT), revealing that FCH-PET/CT offers an equal or even superior detection of MPA [17]. 99m Tc-sestamibi parathyroid scan (SPS) with SPECT/CT were utilized in 53 patients with primary HPT, and revealed that SPS interpretation method correlated perfectly with the surgical finding in 48/53 patients (90.6%); it was on the correct side of the surgical finding but not the exact location in 3/53 (5.7%) and nonlocalizing in 2/53 (3.7%) [17]. SPS was utilized in localization of the MPA in our case with success, thus helping in the selection of the right surgical procedure (thoracotomy) to excise the tumor.…”

Right ectopic paraesophageal parathyroid adenoma with refractory hypercalcemia in pregnancy: A case report and review of the literature

“…Such combination after failed neck exploration can ensure success of the second surgery [ 6 ]. 18F-fluorocholine PET/CT may localize EPA in pregnancy after negative/equivocal US and/or scintigraphy/single-photon emission computed tomography (SPECT) [ 24 ]. A multidisciplinary team can select the appropriate imaging with the least harm to both the mother and fetus [ 25 ].…”

“…In small studies of patients undergoing neck re-exploration, prevalence was 29–45% [ 1 ]. EPA can locate within the mediastinum as observed in Table 1 [ 6 , 12 , 15 , 16 , 24 ] or thymus [ 23 ].…”

Localization of Ectopic Mediastinal Parathyroid Adenomas Using Indigo Carmine Injection for Surgical Management: A Preliminary Report

“…The primary hyperparathyroidism (PHPT) is characterized by the autonomous secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The most frequent cause of PHPT is a benign solitary parathyroid adenoma, which occurs in 80–90% of patients ( 1 , 2 ). An ectopic focus is demonstrated in up to 22% of the patients; the prevalence is even higher in the patients who undergo redo surgery ( 3 , 4 ).…”

“…An ectopic focus is demonstrated in up to 22% of the patients; the prevalence is even higher in the patients who undergo redo surgery ( 3 , 4 ). Surgery is the only definitive cure for PHPT and is indicated in all symptomatic patients, as well as a defined subgroup of asymptomatic patients ( 2 , 5 ). The goals of parathyroid surgery are to remove all hyperfunctioning tissues and to preserve normal parathyroid tissues.…”