case_images: PMC10692408_01
case_images: Technetium 99m sestamibi scan shows intense focal tracer uptake and retention in the left superior mediastinal region.
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case_images: On work-up, skeletal survey revealed brown tumors on the arms (Figure 1) and multiple nonaggressive lytic lesions on the skull.
case_images: Frontal radiograph of both upper femurs shows badly displaced fractures of both upper femoral shafts (red arrows). These pathological fractures have occurred through bilateral underlying osteolytic lesions consistent with brown tumors.
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case_images: PMC10692408_01_JAFES-38-2-145-g002.jpg
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case_images: His legs had multiple fractures described as complete linear displaced fracture at the left femoral neck and complete oblique fracture at the left and right femoral proximal shafts (Figure 2).
case_images: Technetium 99m sestamibi scan shows intense focal tracer uptake and retention in the left superior mediastinal region.
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case_images: PMC10692408_01_JAFES-38-2-145-g003.jpg
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case_images: With a high suspicion of PHPT, a technetium 99m sestamibi scan was performed which revealed an intense focal sestamibi accumulation and retention in the left superior mediastinal region consistent with an ectopic parathyroid adenoma (Figure 3).
case_images: Axial contrast-enhanced CT image shows an enhancing soft tissue nodule in the aortopulmonary window (labelled) consistent with an ectopic parathyroid adenoma. This corresponds to the focus of tracer uptake detected on the Tc-99m sestamibi scan.
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case_images: PMC10692408_01_JAFES-38-2-145-g004.jpg
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case_images: To further localize the parathyroid adenoma, a computed tomography (CT) scan with intravenous contrast was performed on the neck and chest (Figure 4) which showed an avidly enhancing soft tissue nodule in the aortopulmonary window/anterior left mediastinum region consistent with a thymoma and/or residual ectopic parathyroid adenoma.