IS Case 57: Parathyroid Adenoma
Imaging Sciences URMC 2008
Publication Date: 2009-05-19
A 60-year-old female with history of metastatic renal cell carcinoma (RCC) to the lungs presented with a left thyroid nodule seen on chest CT. Thyroid ultrasound was requested for further characterization.
Thyroid US revealed a few sub-centimeter nodules without malignant features in bilateral thyroid lobes. However a predominantly hypoechoic lesion with some internal echoes measuring 2.4 x 0.6 cm was found posterior and inferior to the left thyroid lobe. Color Doppler US demonstrates mild vascularity along the periphery.
Parathyroid adenomas are not routinely visualized on ultrasound; when seen they are often enlarged with associated hyperparathyroidism. Patients should be evaluated for hypercalcemia and elevated PTH.
Parathyroid adenomas are usually oval, hypoechoic, predominantly solid lesions. A small percentage may develop cystic necrosis and hemorrhage when larger than 2cm in size. On color Doppler imaging they are usually hypervascular with “polar vascular arcs” (peripheral blood flow).
- Rumack C, Wilson S, Charboneau JW, Johnson J-A. Diagnostic Ultrasound. 3rd ed., Mosby, 2005:771-789.
- Brant WE. Core Curriculum: Ultrasound. Lippincott, Williams & Wilkins, 2001:359-361.