Images in Surgery| Volume 157, ISSUE 1, P173-175, January 2015

Hyperparathyroidism caused by retroesophageal adenoma located with C-11 methionine PET/CT in a morbidly obese patient

Published:September 13, 2013DOI:
      A 62-year-old woman presented with slight hypophosphatemia (2.4 mg/dL; normal range, 2.5–4.7) and mild hypercalcemia (10.5 mg/dL; normal range, 8.1–10.4) in the preoperative assessment of surgery for morbid obesity (body mass index of 44 kg/m2). Bone densitometry showed severe lumbar osteoporosis, and parathyroid hormone (PTH) levels were 188 pg/mL (reference range, 12–72). Within this frame work, the most probable diagnosis was primary hyperparathyroidism caused by a solitary adenoma. However, neither cervical ultrasonography or scintigraphy with 99mTc-MIBI showed a parathyroid adenoma. C-11 methionine positron emission tomography/computed tomography (Met-PET/CT) showed 1 focal high uptake (SUVmax = 5.5) located in contact with the left posterior wall of cervical esophagus (Fig 1). Endoscopic ultrasonography confirmed the presence of a 3.5-cm, oval-shaped nodule in contact with the posterior surface of the esophagus but not infiltrating esophageal wall.
      Figure thumbnail gr1
      Fig 1Methionine–positron emission tomography/computed tomography showing an uptake (SUV 5,5) located in contact with the posterior wall of the esophagus at the level of the thyroid cartilage.
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