sodium-pertechnetate-tc-99m and Mediastinal-Diseases

Topics: Aged; Female; Goiter, Nodular; Goiter, Substernal; Humans; Mediastinal Diseases; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyrotoxicosis; Tomography, X-Ray Computed

The most common etiologic factor of primary hyperparathyroidism is a solitary parathyroid adenoma that might be located in the mediastinum. The mediastinally located ectopic parathyroid adenomas are often out of reach with a cervical incision and require a thoracic approach. We present a case of 55 year-old female patient with a parathyroid adenoma located anterior to the ascending aorta within the thymus resulting in primary hyperparathyroidism. The patient underwent an extended thymectomy with intraoperative use of a gamma probe as an adjunct to surgical resection which provided the accurate localization of the parathyroid adenoma. Histologic diagnosis confirmed the tumor to be an ectopic parathyroid adenoma. The patient showed an uneventful postoperative period with decreased levels of both calcium and parathyroid hormone. We emphasize that the gamma probe serves as a very useful device to differentiate the ectopic parathyroid adenoma from surrounding tissues for complete surgical excision.

Topics: Adenoma; Choristoma; Female; Humans; Hyperparathyroidism, Primary; Mediastinal Diseases; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Treatment Outcome

Because ectopic parathyroid adenoma (PA) is a frequent cause of failed initial surgery, an imaging approach with accurate preoperative localization is recommended by some authors in patients with primary hyperparathyroidism (HPT).. The authors describe a 52-year-old woman in whom primary HPT was diagnosed incidentally during a screening program for osteoporosis. The peculiarity of this case is that the patient was examined before operation in a single-day multimodal imaging protocol based on the combination of high-resolution cervical ultrasound, planar Tc-99m pertechnetate-MIBI scans, and an MIBI-SPECT-computed tomographic (CT) image fusion study. An ectopic PA was accurately located in the upper middle mediastinum, close to the lower margin of the sternal notch.. Guided by the MIBI-SPECT-CT fusion images, the surgeon performed a limited median sternotomy and easily removed the PA that was revealed before operation. To confirm the completeness of resection, a bilateral neck exploration was performed through the same incision, with identification of three normally sized parathyroid glands.. Our experience suggests the utility of multimodality imaging procedures for the accurate preoperative localization of PAs, particularly when they are present in ectopic mediastinal locations. Such procedures, including the MIBI-SPECT-CT image fusion study, can be performed in a single day.

Topics: Adenoma; Choristoma; Female; Humans; Hyperparathyroidism; Mediastinal Diseases; Middle Aged; Parathyroid Neoplasms; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Compounds; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Adenoma; Adult; Choristoma; Humans; Male; Mediastinal Diseases; Mediastinal Neoplasms; Parathyroid Glands; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

Preoperative localization of abnormal parathyroid tissue in patients with persistent or recurrent hyperparathyroidism is recommended as a standard of care. A high percentage of these patients have ectopic tissue in the mediastinum. Tc-99m MIBI imaging alone for detection of ectopic parathyroid tissue in the mediastinum does not provide a sufficient number of anatomic landmarks, which makes communication regarding the exact location of any area of abnormal uptake difficult. We report the use of concomitant Tc-99m RBC and Tc-99m MIBI imaging for precise anatomic localization of ectopic mediastinal parathyroid tissue in 4 patients. It is thought that this combination of studies allows improved communication with referring physicians, surgeons, and radiologists for planning both surgical approach and correlative imaging studies. It is hoped that in the future this combination of studies may obviate the need for other imaging studies.

Topics: Adenoma; Aged; Choristoma; Communication; Erythrocytes; Female; General Surgery; Humans; Hyperparathyroidism; Hyperplasia; Image Enhancement; Interprofessional Relations; Male; Mediastinal Diseases; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Patient Care Planning; Radiology; Radiopharmaceuticals; Recurrence; Referral and Consultation; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

Radionuclide parathyroid scans are widely used to localize abnormal parathyroid glands. They are especially valuable for identifying ectopic glands, including those in the mediastinum. Two patients with hyperparathyroidism who had mediastinal glands that were not identified because only the neck was scanned prompted our review of the technique of parathyroid scanning at hospitals in our region and of the frequency of mediastinal parathyroid glands identified by scanning at our own institution. The nuclear medicine departments at 72 area hospitals were surveyed. Parathyroid scans were performed at 51 of these hospitals but only 13 (25%) routinely scanned the mediastinum and chest. At our institution 480 parathyroid scans were performed during a 9-year period. Twenty-six mediastinal parathyroid glands were identified by routine scanning of both the neck and mediastinum. Most of these glands could be removed through a cervical incision. However, four required formal thoracotomy and two thoracoscopy.. A radionuclide parathyroid scan limited to the neck is an incomplete study. Scans that do not include the thorax will miss mediastinal glands that occurred in 5 per cent of the patients in our series. Despite this, radionuclide parathyroid scanning was limited to the neck in 75 per cent of surveyed hospitals. This practice increases the chance for failed surgical exploration and increases potential patient morbidity.

Topics: Adenoma; Adult; Choristoma; Female; Humans; Hyperparathyroidism; Male; Mediastinal Diseases; Neck; Nuclear Medicine Department, Hospital; Organizational Policy; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Recurrence; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thoracic Diseases; Thoracostomy; Thoracotomy