case_images: PMC10768879_01
case_images: Gross surgical pathology of resected parathyroid gland weighing 500 mg and measuring 2.5 cm in greater length.
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case_images: The patient underwent right inferior parathyroidectomy and right thyroid lobectomy; during the procedure, the patient was found to have a large right inferior parathyroid gland with a cystic component densely adhered to the strap muscles and the right lobe of the thyroid concerning for malignancy, therefore both were removed (Fig. 1).
case_images: Anterior planar images of the neck and chest acquired (A) 20 minutes and (B) 120 minutes after IV administration of 30.1 mCi 99mTc-sestamibi showed physiological uptake throughout the thyroid gland (black arrows) without discrete focal abnormality to suggest residual parathyroid lesions. Also note, physiological uptake in the liver (L), heart (H) and salivary glands (*).
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case_images: (A) Non-contrast-enhanced axial CT image and (B) IV contrast-enhanced axial CT images during the arterial (20 seconds) and (C) venous (120 seconds) phases of enhancement demonstrated a 1.8 x 1.4 x 3.0 cm and a 1.2 x 0.8 x 2.1 cm (AP x TRV x SAG) hypo-dense lesion with homogenous arterial phase enhancement and delayed phase washout at the level of the cricoid cartridge undersurface, consistent with parathyroid adenomas (white arrows). Additionally, a 0.3 x 0.4 x 0.4 cm parathyroid adenoma was identified posterior to the right carotid artery at the level of the superior aspect of the cricoid cartridge (not shown).
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case_images: US did not reveal evidence of parathyroid abnormalities. Ultimately, the patient was pretreated with glucocorticoids and had a 4D-CT that detected multiglandular disease with a 1.8 x 1.4 x 3.0 cm right superior parathyroid gland weighing approximately 3931 mg, 1.2 x 0.8 x 2.1 cm left superior parathyroid gland weighing approximately 1048 mg, and 0.3 x 0.4 x 0.4 cm left inferior parathyroid weighing approximately 25 mg (Fig. 3A-3C).