Ectopic Mediastinal Parathyroid Adenoma in a Patient with Chronic Kidney Disease: A Case Report

Dong Min Choo; Jin Hwan Kim; Song Soo Kim

doi:10.3348/jksr.2019.80.1.147

Journal List > J Korean Soc Radiol > v.80(1) > 1133055

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Choo, Kim, and Kim: Ectopic Mediastinal Parathyroid Adenoma in a Patient with Chronic Kidney Disease: A Case Report

Case Report

J Korean Soc Radiol 2019;80(1):147-152.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.1.147

Ectopic Mediastinal Parathyroid Adenoma in a Patient with Chronic Kidney Disease: A Case Report

Dong Min Choo, MD, Jin Hwan Kim, MD^∗, Song Soo Kim, MD

Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea

^∗Corresponding author Jin Hwan Kim, MD Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. Tel 82-42-280-7333 Fax 82-42-253-0061 E-mail michelan@cnu.ac.kr

Received 10 April 2018 Revised 23 May 2018 Accepted 17 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report an ectopic mediastinal parathyroid adenoma in a patient with chronic kidney disease who presented with refractory hypercalcemia. Technetium-99m-sestamibi scintigraphy is avaluable imaging technique for the detection of an ectopic parathyroid adenoma in the medi-astinum. The combination of intense contrast enhancement and the identification of a polar vessel on a computed tomography scan will ensure that a radiologist can differentiate a parathyroid adenoma from other pathologies in the mediastinum. By virtue of the advancement of imaging modalities, localization of an ectopic mediastinal parathyroid adenoma prior to surgery is possible and unnecessary neck exploration is avoidable.

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Fig. 1.

An ectopic anterior mediastinal parathyroid adenoma in a 63-year-old woman. A. Initial posteroanterior chest radiograph shows widening with contour bulging of the right mediastinum (arrow). B. A contrast-enhanced chest computed tomography axial image shows a highly enhancing soft tissue mass in the right anterior mediastinum, measuring 4 × 3 cm. The mass is located anterior to the superior vena cava (arrow). C. Three-dimensional volume rendering reconstruction image demonstrates an enlarged tortuous feed-ⁱng artery originating from the right internal mammary artery (arrowheads) and a dilated vein draining to the right internal mammary vein at the inferior pole of the tumor (arrows).

Fig. 1.

An ectopic anterior mediastinal parathyroid adenoma in a 63-year-old woman. D. Early phase (left) and delayed phase (middle) coronaldual-phase Technetium-99m-sestamibi scintigraphy and fused single photon emission computed tomography/computed tomography (right) images depict a focal and persistent abnormal tracer accumulation in the right anterior mediastinal mass. E. Gross specimen photograph shows a resected ectopic parathyroid adenoma (4 cm). The tumor is well encapsulated and firmly adhered to fatty thy-mic tissue.

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