Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Figure 4

Inconclusive sestamibi scintigraphy versus ultrasound with successful localization by four-dimensional computed tomography (4DCT). A 49-year-old female with multiple endocrine neoplasia type 1 (MEN1) and remote prior three-gland parathyroidectomy presents with recurrent hyperparathyroidism. Planar delayed (two hours) sestamibi scintigraphy (a) shows a questionable-inconclusive enlarged right hypermetabolic parathyroid gland in the superior mediastinum (white arrow). Ultrasound with Doppler interrogation (b) is negative for recurrence. Axial (c), coronal (d), and sagittal (e) arterial phase 4DCT was performed to clarify discordant first-line findings and confirm a small hyperenhancing and ectopic right intrathymic parathyroid adenoma (white arrows).