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    7 yr history of recurrent kidney stones. Parathyroid scintigraphy dual-phase 99mTc-Sestamibi + 99mTc-pertechnetate

    Teaching Case

    Case presentation:

    • Female.
    • 30 y.o.
    • 7 year history of recurrent kidney stones.
    • Hypercalcemia(11.4 mg/dL). -IncreasedserumPTH (199 pg/mL).
    • Diagnosticwork-up forsuspectedprimary hyperparathyroidism(performedin a peripheralhospital):
    1. ?Normal neck US examination.
    2. No parathyroid scintigraphy performed.
    3. Measurement of bone mineral density (DEXA): i. vertebral BMD 0.8959 gr/cm2? (T score -1.2; Z score –1.1. ii. femoral? BMD 0.656 gr/cm2 (T score -1.7; Z score –1.7).
    4. 24-hr urinary calcium: 388 mg (100-300).
    5. No Vitamin D deficiency.
    • December 2008, Bilateral neck exploration:
    1. No evidence of abnormal parathyroid glands.
    2. Thymectomy performed because of suspected intra-thymic localization.
    3. Histology: normal thymic tissue.
    • February 2009 (persistent hyperparathyroidism): Small nodule in thymic region (6×8 mm) detected on neck.

    Teaching points:

    • The use of a pin-hole collimator in the neck increases image resolution.
    • The chest is best evaluated with a parallel-hole collimator either as a planar image or using SPECT (better topographic correlation).
    • SPECT(and especially SPECT/CT) is most helpful in evaluation of the mediastinumas the possible site of ectopic parathyroid glands.

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