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Weekly Chest CasesArchive of Old Cases

Case No : 1036 Date 2017-09-04

  • Courtesy of Song Soo Kim, M.D. / Chungnam National University Hospital
  • Age/Sex 64 / F
  • Chief ComplaintNausea and vomiting, onset) 10 days ago - Intermittent nausea from several months ago without medication - unintentional weight loss (4-5 kg) over 6 months
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Ectopic parathyroid adenoma
Radiologic Findings
Initial chest PA shows mediastinal widening with a bulging contour at right paratracheal region and suspicious cortical ballooning at right 5th and 6th ribs.

Chest CT images show a well-defined, highly enhancing mass (about 4-cm -sized) in the anterior mediastinum. Multifocal cortical ballooning in the ribs with or without fracture is also noted. No abnormality is noted in the lung parenchyma.
Brief Review
An ectopic parathyroid adenoma that causes primary hyperparathyroidism is difficult to detect by various imaging modalities, because ectopic parathyroid adenomas are usually small. Therefore, ectopic parathyroid adenomas are often detected either in the preoperative work up of patients who present with hypercalcemia or in postparathyroidectomy patient with persistent hypercalcemia.
Embryology is the key to understanding the normal and ectopic locations of the parathyroid glands. The upper glands are derived from the 4th pharyngeal pouch together with the lateral thyroid, whereas the lower glands are derived from the 3rd pharyngeal pouch together with the thymus.
The clinical and laboratory features of patients with primary hyperparathyroidism due to ectopic adenomas have been reported to be more severe than those with eutopic adenomas, since the former may manifest with higher calcium levels and higher incidence of bone diseases related to primary hyperparathyroidism.
References
1. Naik, D. Video Assisted Thoracoscopic Surgery (VATS) for Excision of an Ectopic Anterior Mediastinal Intra- Thymic Parathyroid Adenoma 2016 Jun, Vol-10(6): PD22-PD24
2. Randall GJ, Zald PB, Cohen JI, Hamilton BE. Contrast-enhanced MDCT characteristics of parathyroid adenomas. AJR 2009;193:W139-W143
3. Eslamy, H.K Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics 2008;28:1461
Please refer to
Case 951 Case 920 Case 526
Keywords
Ectopic parathyroid adenoma, Primary hyperparathyroidism due to parathyroid adenoma, anterior mediastinum,

No. of Applicants : 110

▶ Correct Answer : 34/110,  30.9%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - University Hospitals Cleveland Medical Center , United States AMIT GUPTA
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Other , Korea (South) SEONG SU KANG
  • - Ajou University School of Medicine , Korea (South) YOOLIM BAEK
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Korea (South) HYERIN KIM
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Louisiana State University - Shreveport , United States CARLOS H PREVIGLIANO
  • - , Korea (South) HYEONG GI CHOI
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Max Hospital New Delhi , India RAJESH GOTHI
  • - Ajou University Hospital , Korea (South) SEULGI YOU
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - University of Utah , United States AKIHIKO SAKATA
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - , Japan YOSHITAKA UEDA
▶ Correct Answer as Differential Diagnosis : 8/110,  7.3%
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Complexo Hospitalar Santa Casa - Porto Alegre, Brazil , Brazil Carlos Eduardo Anselmi
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Vikram Hospital , India SANJEEV J MUDAKAVI
  • - Fortis hospital , Mohali , India SHALEEN RANA
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