RT Journal
A1 Axelrod D, Sisson JC, Cho K, Miskulin J, Gauger PG
T1 Appearance of ectopic undescended inferior parathyroid adenomas on technetium tc 99m sestamibi scintigraphy: A lesson from reoperative parathyroidectomy
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD November 1
VO 138
IS 11
SP 1214
OP 1218
DO 10.1001/archsurg.138.11.1214
UL http://dx.doi.org/10.1001/archsurg.138.11.1214
AB Hypothesis 
    Critical postoperative review of technetium Tc 99m sestamibi scintigraphy can identify an undescended parathyroid adenoma on scans initially interpreted as nondiagnostic or negative.Design 
    Case series.Setting 
    A single, tertiary care academic medical center.Patients 
    Three patients with persistent hyperparathyroidism.Intervention 
    Technetium Tc 99m sestamibi scanning.Outcome Measure 
    Medical records, operative reports, selective venous sampling results, and sestamibi scans were reviewed to identify scintigraphic findings diagnostic of an undescended parathyroid adenoma.Results 
    All patients were cured of their persistent or recurrent hyperparathyroidism during reoperation by resection of an undescended inferior parathyroid adenoma. Subsequent review of the preoperative sestamibi scans demonstrated scintigraphic evidence of the undescended adenoma. In each case there was asymmetry in the physiologic activity attributed to the ipsilateral submandibular gland that, in fact, corresponded to an ectopic parathyroid adenoma at the level of the carotid bifurcation.Conclusions 
    Careful attention to the contour of radioactivity in the region of the submandibular salivary gland may alert surgeons to the presence of an undescended inferior adenoma. After corroboration, this finding may facilitate a targeted operation.