Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 780 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
CASE REPORT
Year : 2012  |  Volume : 27  |  Issue : 2  |  Page : 122-123  

Giant cystic parathyroid adenoma with thrombosis of internal jugular vein seen on CT and Tc-99m methoxy isobutyl isonitrile parathyroid scan


1 Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
2 Department of Nuclear Medicine, Dr. Ziauddin Medical University, Karachi, Pakistan

Date of Web Publication18-Apr-2013

Correspondence Address:
Maseeh uz Zaman
Department of Radiology, The Aga Khan University Hospital, Karachi
Pakistan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.110714

Rights and Permissions
   Abstract 

Primary hyper-parathyroidism is attributed by a solitary parathyroid adenoma in 80-85% cases and mostly are non-palpable and needs imaging for localization. Cystic degeneration of parathyroid adenoma is rarely seen in primary hyperparathyroidism. We are presenting a case of giant cystic functioning parathyroid adenoma with associated localized co-morbids.

Keywords: Cystic parathyroid adenoma, internal jugular vein thrombosis, primary hyperparathyroidism, Tc-99m methoxy isobutyl isonitrile


How to cite this article:
Zaman Mu, Fatima N, Sajjad Z. Giant cystic parathyroid adenoma with thrombosis of internal jugular vein seen on CT and Tc-99m methoxy isobutyl isonitrile parathyroid scan. Indian J Nucl Med 2012;27:122-3

How to cite this URL:
Zaman Mu, Fatima N, Sajjad Z. Giant cystic parathyroid adenoma with thrombosis of internal jugular vein seen on CT and Tc-99m methoxy isobutyl isonitrile parathyroid scan. Indian J Nucl Med [serial online] 2012 [cited 2022 Jan 20];27:122-3. Available from: https://www.ijnm.in/text.asp?2012/27/2/122/110714


   Introduction Top


Parathyroid scintigraphy using Tc-99m methoxy isobutyl isonitrile (MIBI) has become a popular imaging modality for localization of functioning parathyroid adenoma. It is considered more important in cases of multi-glandular disease. Localization of adenoma by scintigraphic technique, signs and symptoms has good correlation with size of the adenoma.


   Case Report Top


A 54-year-old female presented with 3 years history of bony pains, muscle weakness, fatigue, and depression with soft tissue swelling over left thyroid bed and left upper limb. Serum calcium and parathormone levels were abnormally high (17.4 mg/dl and 1182 pg/ml, respectively). Tc-99m MIBI scan revealed a large area of non-homogenous tracer uptake over left thyroid bed and superior mediastinum displacing the thyroid toward right [Figure 1]. In view of raised serum calcium and parathormone levels, it was considered a cystic parathyroid adenoma as non-functional (true) parathyroid cysts are also a known entity. [1] An associated cold defect has been reported in patients with cytsic parathyroid adenoma. [2] Cytic adenomas have been reported to occur in hypercalcemic crisis as the result of acute necrosis or hemorrhage of a parathyroidadenoma. [3]
Figure 1: Planar (dual phase) Tc-99m MIBI scan ((a) Anterior chest view at 10 min. (b) 15 min anteriro neck view. (c) 1 h anterior neck view) a large area of non-homogenous tracer uptake over left lower thyroid region with retrosternal extension (arrow) and gross displacement of both lobes of thyroid to right

Click here to view


Computed tomography scan showed a large left-sided parathyroid adenoma with marked cystic changes and thrombosis of left internal jugular vein [Figure 2]. Cystic degeneration of parathyroid adenoma is reported in 1-2% cases with primary hyperparathyroidism, [4],[5] and 4% of abnormal parathyroid glands. [6] Thrombosis of left internal jugular vein has been reported in few case reports. [7] Excisional biopsy revealed cystic parathyroid adenoma with no evidence of malignancy.
Figure 2: Computed tomography scan ((a) Axial. (b) Coronal. (c) Saggital) shows a large hypodense area with enhancing wall (long arrow) over left side of neck extending into retrosternal region and deviating the trachea to right. This represents cystic degeneration of parathyroid adenoma. Thrombosis of left internal jugular vein (short arrow) is also appreciable

Click here to view


 
   References Top

1.Johnson NA, Yip L, Tublin ME. Cystic parathyroid adenoma: Sonographic features and correlation with 99mTc-sestamibi SPECT findings. AJR Am J Roentgenol 2010;195:1385-90.  Back to cited text no. 1
    
2.Ujiki MB, Nayar R, Sturgeon C, Angelos P. Parathyroid cyst: Often mistaken for a thyroid cyst. World J Surg 2007;31:60-4.  Back to cited text no. 2
    
3.Calandra DB, Shah KH, Prinz RA, Sullivan H, Hofmann C, Oslapas R, et al. Parathyroid cysts: A report of eleven cases including two associated with hyperparathyroid crisis. Surgery 1983;94:887-92.  Back to cited text no. 3
    
4.Clark OH. Parathyroid cysts. Am J Surg 1978;135:395-402.  Back to cited text no. 4
    
5.McCoy KL, Yim JH, Zuckerbraun BS, Ogilvie JB, Peel RL, Carty SE. Cystic parathyroid lesions: Functional and nonfunctional parathyroid cysts. Arch Surg 2009;144:52-6.  Back to cited text no. 5
    
6.Randel SB, Gooding GA, Clark OH, Stein RM, Winkler B. Parathyroid variants: US evaluation. Radiology 1987;165:191-4.  Back to cited text no. 6
    
7.McKay GD, Ng TH, Morgan GJ, Chen RC. Giant functioning parathyroid cyst presenting as a retrosternal goitre. ANZ J Surg 2007;77:297-304.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Cystic Parathyroid Adenomas: An Enigmatic Entity and Role of Tc-99 m Sestamibi Scintigraphy
Venkata Subramanian Krishnaraju, Uma Nahar Saikia, Sanjay Kumar Bhadada, Bhagwant Rai Mittal, Ashwani Sood, Priyanka Singh, Divya Dahiya, Poonam Kumari
Endocrine Practice. 2021; 27(6): 614
[Pubmed] | [DOI]
2 Primary hyperparathyroidism-related giant parathyroid adenoma (Review)
Adina Ghemigian, Alexandra Trandafir, Eugenia Petrova, Mara Carsote, Ana Valea, Alexandru Filipescu, Ana-Maria Oproiu, Florica Sandru
Experimental and Therapeutic Medicine. 2021; 23(1)
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
    References
    Article Figures

 Article Access Statistics
    Viewed1209    
    Printed57    
    Emailed0    
    PDF Downloaded82    
    Comments [Add]    
    Cited by others 2    

Recommend this journal